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General NPI Number Information
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NPI Number | 1962489864
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Entity Type | Individual
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Provider Name | NNAMDI C. NWAOGWUGWU M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 882 S KIRKMAN RD SUITE 305
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City | ORLANDO
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State | FL
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Zip | 32811-2600
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Country | US
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Telephone | 407-291-3077
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Fax | 407-291-3122
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Provider Business Mailing Address
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Address Line | 882 S KIRKMAN RD STE 305
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City | ORLANDO
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State | FL
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Zip | 32811-2617
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Country | US
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Telephone | 407-291-3077
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | ME76735
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME76735
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME76735
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License Number State | FL
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