Provider Demographics
NPI:1689191108
Name:USUWA, CHIZOBA (MD)
Entity Type:Individual
Prefix:
First Name:CHIZOBA
Middle Name:
Last Name:USUWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3896
Mailing Address - Country:US
Mailing Address - Phone:870-541-6000
Mailing Address - Fax:
Practice Address - Street 1:1601 W 40TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6069
Practice Address - Country:US
Practice Address - Phone:870-541-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020541207Q00000X
ARE-15827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine