Provider Demographics
NPI:1104435429
Name:EZEKIEL, ISIOMA JEWEL
Entity type:Individual
Prefix:
First Name:ISIOMA
Middle Name:JEWEL
Last Name:EZEKIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 W GREEN TREE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5289
Mailing Address - Country:US
Mailing Address - Phone:414-852-7858
Mailing Address - Fax:
Practice Address - Street 1:5450 W GREEN TREE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5289
Practice Address - Country:US
Practice Address - Phone:414-852-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management