Provider Demographics
NPI:1104994375
Name:NWOSU, CHIKWENDU C (MD)
Entity type:Individual
Prefix:
First Name:CHIKWENDU
Middle Name:C
Last Name:NWOSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3846 E LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9130
Mailing Address - Country:US
Mailing Address - Phone:917-474-0025
Mailing Address - Fax:
Practice Address - Street 1:2919 S ELLSWORTH RD
Practice Address - Street 2:SUITE 139
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2164
Practice Address - Country:US
Practice Address - Phone:917-474-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022624207R00000X
AZ37888208M00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00376722OtherRAILROAD MEDICARE
767486OtherHEALTHLINK
MO207579905Medicaid
AR165740001Medicaid
216979OtherBCBS
P00376722OtherRAILROAD MEDICARE
AZZ140176Medicare PIN