Provider Demographics
NPI:1972721413
Name:NYENWE, EBENEZER AZUBUIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:EBENEZER
Middle Name:AZUBUIKE
Last Name:NYENWE
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:PO BOX 381604
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1604
Mailing Address - Country:US
Mailing Address - Phone:901-580-7070
Mailing Address - Fax:704-270-6925
Practice Address - Street 1:1325 EASTMORELAND AVE STE 510
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7534
Practice Address - Country:US
Practice Address - Phone:901-580-7070
Practice Address - Fax:704-270-6253
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42527207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000339Medicaid
TN6038807OtherBCBS
MS03654763Medicaid
MS03654763Medicaid