Healthcare Provider Details

I. General information

NPI: 1023824083
Provider Name (Legal Business Name): NIDUS HEATHCARE CONSULTING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1003 HARRIER DR
MIDLAND TX
79706-2426
US

IV. Provider business mailing address

1003 HARRIER DR
MIDLAND TX
79706-2426
US

V. Phone/Fax

Practice location:
  • Phone: 773-349-6855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NKECHI EZIRIM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 518-618-8405