Provider Demographics
NPI:1548555782
Name:NWACHUKWU, SCHOLA AMOGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCHOLA
Middle Name:AMOGE
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SCHOLA
Other - Middle Name:
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:751 N RUTLEDGE
Mailing Address - Street 2:PO BOX 19636
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9636
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-1229
Practice Address - Street 1:751 N RUTLEDGE ST STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-1229
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51827207R00000X
IL036-144091207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-144091OtherSTATE LICENSE
TNQ008743Medicaid