Provider Demographics
NPI:1265884100
Name:EZIOKWU, AKAOLISA SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:AKAOLISA
Middle Name:SAMUEL
Last Name:EZIOKWU
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 1:4435 STATE ROUTE 159
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8620
Mailing Address - Country:US
Mailing Address - Phone:740-542-3030
Mailing Address - Fax:
Practice Address - Street 1:4435 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8620
Practice Address - Country:US
Practice Address - Phone:740-542-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134475207R00000X, 207RH0003X
OH57.027608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173392Medicaid