Provider Demographics
NPI:1891945184
Name:NYATSANZA, IGNATIUS (MD)
Entity Type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:
Last Name:NYATSANZA
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:DIVISION OF HEMATOLOGY ONCOLOGY
Mailing Address - Street 2:840 S WOOD ST STE 820-E CSB MC 713
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-9424
Mailing Address - Fax:312-413-4131
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:405-713-7403
Practice Address - Fax:405-713-2794
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137514207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology