Healthcare Provider Details

I. General information

NPI: 1699478289
Provider Name (Legal Business Name): OBINNA NWAKEZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W STURTEVANT ST
ORLANDO FL
32806
US

IV. Provider business mailing address

316 BURKEWOOD DR
WINSTON SALEM NC
27104-3941
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1699478289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: