Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016005543 | IL |
Y | 222Z00000X | Podiatrist | 016005543 | IL |
N | 213EP0504X | Public Medicine | 016005543 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 016005543 | IL |
N | 111NR0200X | Radiology | 016005543 | IL |
N | 213ER0200X | Radiology | 016005543 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016005543 | IL |
NPI | 1801143482 |
---|---|
Provider Name | Dr. Onwukamike Patrick Nwankpa |
First Address | Evanston, IL 60201-3935 |
Second Address | Evanston, IL 60201-3935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 06/11/2013 |