Provider Demographics
NPI:1548555782
Name:NWACHUKWU, SCHOLA AMOGE (MD)
Entity type:Individual
Prefix:DR
First Name:SCHOLA
Middle Name:AMOGE
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SCHOLA
Other - Middle Name:
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7259 S BINGHAM JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4860
Mailing Address - Country:US
Mailing Address - Phone:801-930-3297
Mailing Address - Fax:
Practice Address - Street 1:10101 SE MAIN ST STE 2011
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2457
Practice Address - Country:US
Practice Address - Phone:503-261-6912
Practice Address - Fax:503-251-6357
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51827207R00000X
IL036-144091207RE0101X
ORMD224537207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-144091OtherSTATE LICENSE
TNQ008743Medicaid