Provider Demographics
NPI:1497922074
Name:NWOBODO, IFEANYICHUKWU NWOBODO (MD)
Entity Type:Individual
Prefix:
First Name:IFEANYICHUKWU
Middle Name:NWOBODO
Last Name:NWOBODO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IFEANYI
Other - Middle Name:NWOBODO
Other - Last Name:NWOBODO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 462125
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80046-2125
Mailing Address - Country:US
Mailing Address - Phone:510-427-8548
Mailing Address - Fax:
Practice Address - Street 1:24974 E GLASGOW DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016
Practice Address - Country:US
Practice Address - Phone:510-427-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT 13483208M00000X
IN01071881A208M00000X, 207R00000X
CODR-52107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist