Provider Demographics
NPI:1003260019
Name:NWADUKWE, IFEANYI VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:VICTOR
Last Name:NWADUKWE
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 1:5481 W WATERS AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1256
Mailing Address - Country:US
Mailing Address - Phone:813-577-4686
Mailing Address - Fax:813-577-4694
Practice Address - Street 1:5481 W WATERS AVE STE 111
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1256
Practice Address - Country:US
Practice Address - Phone:813-577-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37640207ZP0102X, 207ZC0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program