Individual
MBONU NNAJI IKEZUAGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3925 N GATEWAY DR, APPLETON, WI 54913-7863
(920) 702-6371
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 702-6371
(920) 993-5037
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35-099233
OH
207R00000X
Internal Medicine Physician
Primary
81640
WI
208M00000X
Hospitalist Physician
81640
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067250
—
OH
01
—
35-099233
OHIO MEDICAL LICENSE
OH
Enumeration date
07/01/2009
Last updated
09/04/2024
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