Provider Demographics
NPI:1043291735
Name:NWIZU, MARCEL N (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:N
Last Name:NWIZU
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 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2074
Mailing Address - Country:US
Mailing Address - Phone:330-343-0890
Mailing Address - Fax:330-343-0914
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2074
Practice Address - Country:US
Practice Address - Phone:330-343-0890
Practice Address - Fax:330-343-0914
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2669-N174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870679Medicaid
OHF17718Medicare UPIN
OH0710343Medicare ID - Type Unspecified