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General NPI Number Information
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NPI Number | 1588075626
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Entity Type | Individual
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Provider Name | NONSO ANDREW EZEMA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 658 W MARKET ST STE 106
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City | LIMA
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State | OH
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Zip | 45801-5602
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Country | US
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Telephone | 419-228-3335
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Fax | 419-226-5013
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Provider Business Mailing Address
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Address Line | 5241 W GALEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60639-4160
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Country | US
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Telephone | 708-941-3516
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 28706
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.130914
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License Number State | IL
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