Provider Demographics
NPI:1871676064
Name:MAURICE NDUKWU PC
Entity Type:Organization
Organization Name:MAURICE NDUKWU PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IKEADI
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:NDUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-879-0333
Mailing Address - Street 1:8733 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9330
Mailing Address - Country:US
Mailing Address - Phone:219-879-0333
Mailing Address - Fax:219-879-0325
Practice Address - Street 1:8733 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9330
Practice Address - Country:US
Practice Address - Phone:219-879-0333
Practice Address - Fax:219-879-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004881A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty