Provider Demographics
NPI:1932309440
Name:NWAFO, KENECHUKWU EMEKA (MD)
Entity Type:Individual
Prefix:
First Name:KENECHUKWU
Middle Name:EMEKA
Last Name:NWAFO
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 1:13777 SUNNYVALE LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-6403
Mailing Address - Country:US
Mailing Address - Phone:215-990-5601
Mailing Address - Fax:
Practice Address - Street 1:13777 SUNNYVALE LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-6403
Practice Address - Country:US
Practice Address - Phone:215-990-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064281A207R00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000978237OtherANTHEM
IN200873190Medicaid
IN259370128Medicare PIN
IN815500J9Medicare PIN
INP00454580Medicare PIN