Provider Demographics
NPI:1366636235
Name:NWABUKO, ONYEKACHI U (MD)
Entity Type:Individual
Prefix:
First Name:ONYEKACHI
Middle Name:U
Last Name:NWABUKO
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:765-552-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068622A207Q00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993710Medicaid
INM400053950Medicare PIN
INP01401794Medicare PIN
INM400042282Medicare PIN
INM400042287Medicare PIN
IN264430087Medicare PIN
INM400042261Medicare PIN
INM400042264Medicare PIN
INM400042290Medicare PIN
INM400042278Medicare PIN
IN200993710Medicaid
INM400053946Medicare PIN