Provider Demographics
NPI:1639267842
Name:IZIMA, NDUBISI EZE (DO)
Entity Type:Individual
Prefix:DR
First Name:NDUBISI
Middle Name:EZE
Last Name:IZIMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 N EATON
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224
Mailing Address - Country:US
Mailing Address - Phone:517-881-6493
Mailing Address - Fax:
Practice Address - Street 1:1302 N EATON ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1041
Practice Address - Country:US
Practice Address - Phone:517-629-9551
Practice Address - Fax:517-629-9662
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF07125Medicare UPIN