MEDICARE: MICHAEL NZEOGU 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
1	207X00000X	Orthopaedic Surgery Physician	A168173	CA

General Provider Information

NPI Number	:	1336520345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NZEOGU MD

Provider Business Mailing Address
First Line	:	1115 BOULDERS PKWY STE 200
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-215-3063
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVE
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314
Country	:	US
Telephone Number	:	703-810-5209
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	11/30/2022

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