1710418074 NPI number — DR. EBERECHI CORNELIA EKECHUKWU M.D.

Table of content: DR. EBERECHI CORNELIA EKECHUKWU M.D. (NPI 1710418074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710418074 NPI number — DR. EBERECHI CORNELIA EKECHUKWU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKECHUKWU
Provider First Name:
EBERECHI
Provider Middle Name:
CORNELIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710418074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIBLEY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51249-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-754-3658
Provider Business Mailing Address Fax Number:
712-754-2634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIBLEY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51249-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-754-3658
Provider Business Practice Location Address Fax Number:
712-754-2634
Provider Enumeration Date:
03/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD-47093 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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