Provider Demographics
NPI:1598778177
Name:OSONDU, NGOZI ADAMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NGOZI
Middle Name:ADAMMA
Last Name:OSONDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9538 W KEYSER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2909
Mailing Address - Country:US
Mailing Address - Phone:602-206-0403
Mailing Address - Fax:623-362-2954
Practice Address - Street 1:19841 N 27TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4003
Practice Address - Country:US
Practice Address - Phone:623-879-7336
Practice Address - Fax:623-362-2954
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31628207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ784472Medicaid
AZ1598778177Medicare UPIN
AZ78704Medicare PIN