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NPI Code Detail

MEDICARE: NKIRUKA C EZENWA M.D

MEDICARE: NKIRUKA C EZENWA M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician50713TN

General Provider Information

NPI Number : 1225340649
Entity Type Code : Individual
Provider Name (Legal Business Name) : NKIRUKA C EZENWA M.D
Provider Business Mailing Address
First Line : PO BOX 1000
Second Line : DEPT 978
City : MEMPHIS
State : TN
Zip : 38148-0001
Country : US
Telephone Number : 901-758-9900
Fax Number : 901-752-2335
Provider Business Practice Location Address
First Line : 3876 NEW COVINGTON PIKE
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2512
Country : US
Telephone Number : 901-377-2711
Fax Number : 901-387-2036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 10/05/2016

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Directions to “ NKIRUKA C EZENWA M.D” Practice Location

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