Individual
DR. CHUCK G NWAKANMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 RANDALLIA DR., FORT WAYNE, IN 46805-4738
(260) 373-6315
(260) 373-6348
Mailing address
1234 E. DUPONT RD., SUITE 3, FORT WAYNE, IN 46825-1545
(260) 373-9728
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01067430A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036-104042
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2006015249
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301082608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000635990
ANTHEM
IN
01
—
000000772101
BCBS
IN
05
—
200962220
—
IN
01
—
P00803485
R.R. MEDICARE
IN
Enumeration date
06/27/2006
Last updated
10/18/2012
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