Individual
DR. ODILICHI EZENWANNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1820 PEABODY ST, TUNICA, MS 38676-9441
(662) 363-3656
Mailing address
1820 PEABODY ST, TUNICA, MS 38676-9441
(662) 363-3656
(662) 363-3789
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
27125
MS
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
67275
WI
Other
Enumeration date
07/27/2010
Last updated
02/18/2020
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