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NPI Code Detail

MEDICARE: DR. NNAMDI AMACHUKWU MD

MEDICARE: DR. NNAMDI AMACHUKWU 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 Physician341101LA

General Provider Information

NPI Number : 1578138814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NNAMDI AMACHUKWU MD
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 701 E MARSHALL AVE STE 400
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5595
Country : US
Telephone Number : 903-315-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2021
Last Update Date : 09/16/2024

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