Provider Demographics
NPI:1669509931
Name:IHENETU, EZE P (BS)
Entity Type:Individual
Prefix:MR
First Name:EZE
Middle Name:P
Last Name:IHENETU
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S. ONEIDA STREET
Mailing Address - Street 2:APARTMENT 9-202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224
Mailing Address - Country:US
Mailing Address - Phone:303-907-8986
Mailing Address - Fax:
Practice Address - Street 1:1200 S ONEIDA ST
Practice Address - Street 2:APARTMENT 9-202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3112
Practice Address - Country:US
Practice Address - Phone:303-907-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator