Basic Information
| Provider Information | |||||||||
| NPI: | 1831510536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IFEANYICHUKWU NWOBODO MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 462125 | ||||||||
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| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800462125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104278548 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 24974 E GLASGOW DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800163111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104278548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2013 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | NWOBODO | ||||||||
| AuthorizedOfficialFirstName: | IFEANYICHUKWU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5104278548 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR.0052107 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.