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General NPI Number Information
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NPI Number | 1760672497
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Entity Type | Individual
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Provider Name | CHUKWUDI EMMANUEL NWODO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DR
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City | LEBANON
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State | MO
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Zip | 65536-9210
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Country | US
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Telephone | 417-533-6350
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Fax |
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Provider Business Mailing Address
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Address Line | 4428 E AMBROSE DR
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City | SPRINGFIELD
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State | MO
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Zip | 65802-2446
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Country | US
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Telephone | 302-465-5442
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2010019787
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License Number State | MO
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