MEDICARE: CHINEZE NWAKEGO ENWONWU D.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
1	122300000X	Dentist	30. 023597	OH

General Provider Information

NPI Number	:	1316201247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINEZE NWAKEGO ENWONWU D.M.D.

Provider Business Mailing Address
First Line	:	2591 S BELVOIR BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 S BELVOIR BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4621
Country	:	US
Telephone Number	:	216-371-4825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	02/03/2014

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