MEDICARE: DR. ODILICHI EZENWANNE 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	2083P0901X	Public Health & General Preventive Medicine Physician	27125	MS
2	2083P0901X	Public Health & General Preventive Medicine Physician	67275	WI

General Provider Information

NPI Number	:	1841504206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ODILICHI EZENWANNE M.D.

Provider Business Mailing Address
First Line	:	1820 PEABODY ST
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9441
Country	:	US
Telephone Number	:	662-363-3656
Fax Number	:	662-363-3789

Provider Business Practice Location Address
First Line	:	1820 PEABODY ST
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9441
Country	:	US
Telephone Number	:	662-363-3656
Fax Number	:

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

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	02/18/2020

Similar Medicare Providers

1609874700 — AARON E HENRY COMMUNITY HEALTH
Practice Location Address:

1820 PEABODY ST
TUNICA, MS
38676-9441

Practice Phone: 662-363-3656
Practice Fax: 662-363-3789

1720088016 — DR. OLUGBENGA ADEDIPE MD
Practice Location Address:

1820 PEABODY ST
TUNICA, MS
38676-9441

Practice Phone: 662-363-3656
Practice Fax: 662-363-3789

1750904595 — ARIEL POWELL NP
Practice Location Address:

1820 PEABODY ST
TUNICA, MS
38676-9441

Practice Phone: 662-363-3971
Practice Fax:

1912905993 — AARON E HENRY COMMUNITY HEALTH
Practice Location Address:

744 SCHOOL ST
TUNICA, MS
38676-9369

Practice Phone: 662-363-3971
Practice Fax: 662-363-3789

1265429971 — TUNICA NURSING HOME
Practice Location Address:

1024 HIGHWAY 61 S
TUNICA, MS
38676-9440

Practice Phone: 662-363-3164
Practice Fax: 662-363-4191

1538120258 — PREVENTIVE CARE HEALTH SERVICES LLC
Practice Location Address:

2073 OLD HIGHWAY 61 N , STE#2
TUNICA, MS
38676

Practice Phone: 662-357-7602
Practice Fax: 662-357-7621

Directions to “ DR. ODILICHI EZENWANNE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.