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NPI Code Detail

MEDICARE: DR. NANDAWULA KANYEREZI MUTEMA MD

MEDICARE: DR. NANDAWULA KANYEREZI MUTEMA MD
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
1207R00000XInternal Medicine Physician35072466OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265418362
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANDAWULA KANYEREZI MUTEMA MD
Provider Business Mailing Address
First Line : 3101 BURNET AVENUE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3098
Country : US
Telephone Number : 513-357-7289
Fax Number : 513-263-8787
Provider Business Practice Location Address
First Line : 5818 MADISON RD
Second Line : BRAXTON CANN HEALTH CENTER
City : CINCINNATI
State : OH
Zip : 45227-1708
Country : US
Telephone Number : 513-263-8750
Fax Number : 513-263-8787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 02/25/2013

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