Provider Demographics
NPI:1467518829
Name:EMMANUEL K ONWUTUEBE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EMMANUEL K ONWUTUEBE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ONWUTUEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-909-3300
Mailing Address - Street 1:6970 W. PATRICK LANE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0270
Mailing Address - Country:US
Mailing Address - Phone:702-450-1717
Mailing Address - Fax:702-947-6740
Practice Address - Street 1:6970 W. PATRICK LANE
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0270
Practice Address - Country:US
Practice Address - Phone:702-450-1717
Practice Address - Fax:702-947-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018728Medicaid
H77440Medicare UPIN
NVV103418Medicare PIN
NV002018728Medicaid