Healthcare Provider Details

I. General information

NPI: 1588075626
Provider Name (Legal Business Name): NONSO ANDREW EZEMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W MARKET ST STE 106
LIMA OH
45801-5602
US

IV. Provider business mailing address

5241 W GALEWOOD AVE
CHICAGO IL
60639-4160
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax: 419-226-5013
Mailing address:
  • Phone: 708-941-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28706
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.130914
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: