Individual
MR. NKEMAKOLAM IROEGBU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1915 LAKE AVE, PLYMOUTH, IN 46563-9366
(574) 335-5000
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01042876
IN
207R00000X
Internal Medicine Physician
036091295
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000877923
BCBS
IN
01
—
01628310
BCBS PROVIDER #
IL
05
—
036091925
—
IL
05
—
201169800
—
IN
Enumeration date
06/17/2006
Last updated
03/07/2023
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