Provider Demographics
NPI:1396056404
Name:OFIKWU, GODWIN INALEGWU
Entity type:Individual
Prefix:DR
First Name:GODWIN
Middle Name:INALEGWU
Last Name:OFIKWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WIGWAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8172
Mailing Address - Country:US
Mailing Address - Phone:702-852-1888
Mailing Address - Fax:702-829-8399
Practice Address - Street 1:1040 WIGWAM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8172
Practice Address - Country:US
Practice Address - Phone:702-852-1888
Practice Address - Fax:702-829-8399
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108393208C00000X
390200000X
NV16681208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program