Provider Demographics
NPI:1861606451
Name:MBAH, NGOZI NWAMAKA (MD)
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:NWAMAKA
Last Name:MBAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 DEVELOPMENT DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4240
Mailing Address - Country:US
Mailing Address - Phone:920-338-6868
Mailing Address - Fax:920-338-6859
Practice Address - Street 1:2641 DEVELOPMENT DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-338-6868
Practice Address - Fax:920-338-6859
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIMT189119207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology