Basic Information
| Provider Information | |||||||||
| NPI: | 1336520345 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NZEOGU | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042153063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 BALLENGER AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A168173 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.