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General NPI Number Information
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NPI Number | 1356661433
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Entity Type | Individual
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Provider Name | UGONNA THOMAS NWANKWO MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 4921 PARKVIEW PL DIV IM CARDIOLOGY, STE 8B
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1032
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Country | US
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Telephone | 314-362-1291
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Fax | 314-747-8213
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-362-1291
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Fax | 314-747-8213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2020041928
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2020041928
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2020041928
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 2020041928
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number | 2020041928
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License Number State | MO
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