Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036-119606 | IL |
Y | 111NI0900X | Internist | 036-119606 | IL |
N | 207R00000X | Internist | A95863 | CA |
N | 111NI0900X | Internist | A95863 | CA |
N | 207RG0300X | Geriatric Medicine | 036.119606 | IL |
NPI | 1053322503 |
---|---|
Provider Name | Dr. Rex Chukwuma Nzeribe |
First Address | Chicago, IL 60607-1644 |
Second Address | Oakhurst, CA 93644-8702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 26/12/2018 |