Provider Demographics
NPI:1588633564
Name:NWANERI, MATTHEW OBINNA (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OBINNA
Last Name:NWANERI
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 1:2344 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-0200
Practice Address - Fax:612-863-0235
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32099207RX0202X
MN40093207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1027962OtherPREFERREDONE
MN66B30NWOtherBLUE CROSS BLUE SHIELD MN
MNHP32907OtherHEALTHPARTNERS
WI34073300Medicaid
MN3600160OtherMEDICA
MN779432100Medicaid
MT0057086Medicaid
MN1210163OtherAMERICA'S PPO
MN151706OtherUCARE MN
WI34073300Medicaid
MT0057086Medicaid
MN151706OtherUCARE MN