Basic Information
| Provider Information | |||||||||
| NPI: | 1588633564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NWANERI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | OBINNA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | C21 GH | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193562148 | ||||||||
| FaxNumber: | 3193568383 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | C21 GH | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193562148 | ||||||||
| FaxNumber: | 3193568383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 32099 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3600160 | 01 | MN | MEDICA | OTHER | 1027962 | 01 | MN | PREFERREDONE | OTHER | 34073300 | 05 | WI | MEDICAID | 66B30NW | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 779432100 | 05 | MN | MEDICAID | 0057086 | 05 | MT | MEDICAID | 1210163 | 01 | MN | AMERICA'S PPO | OTHER | 151706 | 01 | MN | UCARE MN | OTHER | HP32907 | 01 | MN | HEALTHPARTNERS | OTHER |