Provider Demographics
NPI:1447224431
Name:ONWUTUEBE, EMMANUEL K (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:K
Last Name:ONWUTUEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3860 W ANN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4410
Mailing Address - Country:US
Mailing Address - Phone:702-450-1717
Mailing Address - Fax:702-947-6740
Practice Address - Street 1:7575 W WASHINGTON AVE # 127-156
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4333
Practice Address - Country:US
Practice Address - Phone:702-450-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018728Medicaid
NV2018728Medicaid
H77440Medicare UPIN