Provider Demographics
NPI:1316443724
Name:IGWE, JOHN C (DO, PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:IGWE
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SOUTH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3644
Mailing Address - Country:US
Mailing Address - Phone:330-507-0625
Mailing Address - Fax:
Practice Address - Street 1:7000 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3644
Practice Address - Country:US
Practice Address - Phone:330-507-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine