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General NPI Number Information
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NPI Number | 1992556435
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Entity Type | Individual
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Provider Name | MR. EMEKA IWENOFU
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Gender | Male
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 10533 BALTIC RD
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City | CLEVELAND
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State | OH
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Zip | 44102-1634
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Country | US
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Telephone | 216-255-1395
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Fax |
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Provider Business Mailing Address
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Address Line | 12610 TRISKETT RD # M11
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City | CLEVELAND
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State | OH
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Zip | 44111-2541
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Country | US
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Telephone | 216-255-1395
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | RW713755
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License Number State | OH
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