Provider Demographics
NPI:1821476185
Name:NWABUNIKE, TOCHUKWU (MD)
Entity Type:Individual
Prefix:
First Name:TOCHUKWU
Middle Name:
Last Name:NWABUNIKE
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 1:50673 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4932
Mailing Address - Country:US
Mailing Address - Phone:574-239-5958
Mailing Address - Fax:
Practice Address - Street 1:50673 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4932
Practice Address - Country:US
Practice Address - Phone:574-239-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080245A207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program