Provider Demographics
NPI:1164155644
Name:EZEANI, CHUKWUNONSO BENEDICT (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUNONSO
Middle Name:BENEDICT
Last Name:EZEANI
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 1:5010 MANCUSO LN APT 621
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-0518
Mailing Address - Country:US
Mailing Address - Phone:346-538-4593
Mailing Address - Fax:
Practice Address - Street 1:3401 NORTH BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3743
Practice Address - Country:US
Practice Address - Phone:225-387-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332274390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program