Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 061267 | GA |
N | 111NI0900X | Internist | 061267 | GA |
N | 207R00000X | Internist | 50418-020 | WI |
N | 111NI0900X | Internist | 50418-020 | WI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 13512 | NV |
NPI | 1023167525 |
---|---|
Provider Name | Kenneth Ejikeme Izuora |
First Address | Las Vegas, NV 89102-1973 |
Second Address | Las Vegas, NV 89102-2353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100500484GROUP | (05) | NV |