Basic Information
| Provider Information | |||||||||
| NPI: | 1588686695 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EGWUATU | ||||||||
| FirstName: | NNAEMEKA | ||||||||
| MiddleName: | EKEKWE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 STATE ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169131808 | ||||||||
| FaxNumber: | 6169131818 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 CHERRY ST SE | ||||||||
| Address2: | STE 306 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169138200 | ||||||||
| FaxNumber: | 6167740158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207RI0200X | 4301088694 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.