Healthcare Provider Details

I. General information

NPI: 1588633564
Provider Name (Legal Business Name): MATTHEW OBINNA NWANERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/18/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST STE 401
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2344 E WASHINGTON ST
IOWA CITY IA
52245-3639
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-0200
  • Fax: 612-863-0235
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number32099
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number40093
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: