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General NPI Number Information
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NPI Number | 1679772198
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Entity Type | Individual
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Provider Name | CHRISTIAN C NWANKWO MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD SUITE 374B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-842-9669
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Fax | 314-842-1017
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Provider Business Mailing Address
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Address Line | PO BOX 802841
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City | KANSAS CITY
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State | MO
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Zip | 64180-2841
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Country | US
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Telephone | 314-842-9669
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Fax | 314-842-1017
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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 | 2007007870
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2010019786
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License Number State | MO
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