Provider Demographics
NPI:1265654164
Name:UZOCHUKWU, NZEADIBENMA O (MD)
Entity Type:Individual
Prefix:
First Name:NZEADIBENMA
Middle Name:O
Last Name:UZOCHUKWU
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 13491
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62791
Mailing Address - Country:US
Mailing Address - Phone:217-544-2149
Mailing Address - Fax:217-544-9553
Practice Address - Street 1:800 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-544-2149
Practice Address - Fax:217-544-9553
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2312762085R0202X
SC293332085R0202X
LA14221R2085R0202X
NC2007005772085R0202X
NJ25MA083925002085R0202X
IL0361218332085R0202X
GA597852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22186Medicare UPIN