Provider Demographics
NPI:1154419521
Name:EZE, CHUKWUMA E (MD)
Entity type:Individual
Prefix:DR
First Name:CHUKWUMA
Middle Name:E
Last Name:EZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1328
Mailing Address - Country:US
Mailing Address - Phone:937-438-3132
Mailing Address - Fax:937-438-8707
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR.
Practice Address - Street 2:SUITE 220
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-438-0099
Practice Address - Fax:937-438-0902
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090623207RN0300X
LAMD025756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAI07191Medicare UPIN