Basic Information
| Provider Information | |||||||||
| NPI: | 1497922074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NWOBODO | ||||||||
| FirstName: | IFEANYICHUKWU | ||||||||
| MiddleName: | NWOBODO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NWOBODO | ||||||||
| OtherFirstName: | IFEANYI | ||||||||
| OtherMiddleName: | NWOBODO | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 462125 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800462125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104278548 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24974 E GLASGOW DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104278548 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | PT 13483 | ND | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 01071881A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 01071881A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR-52107 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.