Provider Demographics
NPI:1881879716
Name:NWIZU, TOBENNA IGWEONU (MD)
Entity type:Individual
Prefix:DR
First Name:TOBENNA
Middle Name:IGWEONU
Last Name:NWIZU
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:7501 LAKEVIEW PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9330
Practice Address - Country:US
Practice Address - Phone:972-412-2577
Practice Address - Fax:972-412-0398
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120500207R00000X
OH099327207RH0003X
TXQ6352207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354740803Medicaid
TX354740804Medicaid
TX471135YKYCMedicare PIN
TX354740803Medicaid