Provider Demographics
NPI:1447213822
Name:EGBO, CHINWE J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINWE
Middle Name:J
Last Name:EGBO
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:PO BOX 11773
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0013
Mailing Address - Country:US
Mailing Address - Phone:480-907-7707
Mailing Address - Fax:
Practice Address - Street 1:10835 NORTH 25TH AVENUE
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3452
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:602-789-8389
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33581207R00000X
AZ33582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ930158-01Medicaid
AZ930158-01Medicaid
AZI28452Medicare UPIN