Provider Demographics
NPI:1356321392
Name:IWEHA, CHIOMA N (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:N
Last Name:IWEHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 W THUNDERBIRD RD STE E100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5048
Mailing Address - Country:US
Mailing Address - Phone:623-241-9028
Mailing Address - Fax:623-241-9029
Practice Address - Street 1:6760 W THUNDERBIRD RD STE E100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5048
Practice Address - Country:US
Practice Address - Phone:623-241-9028
Practice Address - Fax:623-241-9029
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26965207RE0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ711342Medicaid
AZH76824Medicare UPIN