Provider Demographics
NPI:1164643623
Name:NWUMEH, EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:NWUMEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5903
Mailing Address - Country:US
Mailing Address - Phone:708-275-0901
Mailing Address - Fax:309-736-3360
Practice Address - Street 1:3061 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5903
Practice Address - Country:US
Practice Address - Phone:708-275-0901
Practice Address - Fax:708-275-0901
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063204207Q00000X
IL036.117498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.117498OtherILLINOIS LICENSE NUMBER
IL$$$$$$$$$Medicaid
IL420340002Medicare PIN