Provider Demographics
NPI:1932583804
Name:MUGWERU, JON (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:MUGWERU
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:PO BOX 85378
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5378
Mailing Address - Country:US
Mailing Address - Phone:336-274-6682
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-6682
Practice Address - Fax:336-274-8097
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
SC872192085R0204X
FLTRN21721390200000X
NC2022-005032085R0204X
VA01012740072085R0204X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program