Provider Demographics
NPI:1962489864
Name:NWAOGWUGWU, NNAMDI C (MD)
Entity Type:Individual
Prefix:DR
First Name:NNAMDI
Middle Name:C
Last Name:NWAOGWUGWU
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 1:882 S KIRKMAN RD
Mailing Address - Street 2:STE 305
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2617
Mailing Address - Country:US
Mailing Address - Phone:407-291-3077
Mailing Address - Fax:
Practice Address - Street 1:882 S KIRKMAN RD
Practice Address - Street 2:SUITE 305
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2600
Practice Address - Country:US
Practice Address - Phone:407-291-3077
Practice Address - Fax:407-291-3122
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76735204C00000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG82886Medicare UPIN
E3591Medicare ID - Type Unspecified