Provider Demographics
NPI:1851338032
Name:NWILOH, VICTOR MADUABUCHI (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MADUABUCHI
Last Name:NWILOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 963207
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-3207
Mailing Address - Country:US
Mailing Address - Phone:915-300-2276
Mailing Address - Fax:866-665-6659
Practice Address - Street 1:2204 JOE BATTLE BLVD # D204
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4660
Practice Address - Country:US
Practice Address - Phone:915-300-2276
Practice Address - Fax:866-665-6659
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91251207R00000X
WAMD00047521207R00000X
FLME 91251207R00000X
TXN5914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00388656OtherRR MCARE
FL53528OtherBCBS
FL2757770-00Medicaid
GA803343252BMedicaid
WA8473498Medicaid
FLU6900AMedicare PIN
WAP00388656OtherRR MCARE
GAI05112Medicare UPIN
TX284778ZGUFMedicare PIN
GA803343252BMedicaid