Healthcare Provider Details

I. General information

NPI: 1366645848
Provider Name (Legal Business Name): DR. IKECHUKWU ONYEKACHI NWOBU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR STE 403
HIGH POINT NC
27265-8357
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2930
  • Fax: 336-802-2931
Mailing address:
  • Phone: 336-716-1331
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200800200
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2008-00200
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: