Healthcare Provider Details

I. General information

NPI: 1104116169
Provider Name (Legal Business Name): JOHN CHIMA NWANKWO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 W IH 10
SAN ANTONIO TX
78201-2009
US

IV. Provider business mailing address

1305 WALT WHITMAN RD STE 300
MELVILLE NY
11747-4300
US

V. Phone/Fax

Practice location:
  • Phone: 210-736-6700
  • Fax:
Mailing address:
  • Phone: 860-918-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU5302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: