MEDICARE: DR. EBELECHUKWU NWAGBATA 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	207Q00000X	Family Medicine Physician	036-117140	IL

General Provider Information

NPI Number	:	1508997925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBELECHUKWU NWAGBATA M.D

Provider Business Mailing Address
First Line	:	15 WALLER ST
Second Line	:	5TH FLOOR, ATT: FINANCE
City	:	AUSTIN
State	:	TX
Zip	:	78702-5240
Country	:	US
Telephone Number	:	512-978-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 S IH 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-4824
Country	:	US
Telephone Number	:	512-978-9960
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/06/2013

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