Provider Demographics
NPI:1033370986
Name:EZE, NNAMDI IFEANYI (MD)
Entity Type:Individual
Prefix:DR
First Name:NNAMDI
Middle Name:IFEANYI
Last Name:EZE
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 1:2004 HAYES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2659
Mailing Address - Country:US
Mailing Address - Phone:615-514-6963
Mailing Address - Fax:
Practice Address - Street 1:120 FRANK MARTIN RD STE 102
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7195
Practice Address - Country:US
Practice Address - Phone:931-680-0602
Practice Address - Fax:931-680-0654
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD56260207RH0003X, 207RH0003X
PAMT192122390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0274275Medicaid
TNQ030935Medicaid
PA102638218Medicaid
PA102638218Medicaid