Healthcare Provider Details

I. General information

NPI: 1528763893
Provider Name (Legal Business Name): CHUKWUDI ISREAL AGBOR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/10/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, 8701 WATERTOWN PLANK RD.,
MILWAUKEE WI
53226
US

IV. Provider business mailing address

MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, 8701 WATERTOWN PLANK RD.,
MILWAUKEE WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-4578
  • Fax:
Mailing address:
  • Phone: 414-955-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: