Provider Demographics
NPI:1174537138
Name:AMANAMBU, CHIMEZIE C (MD)
Entity type:Individual
Prefix:
First Name:CHIMEZIE
Middle Name:C
Last Name:AMANAMBU
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 1:852 CRICKET CIR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2743
Mailing Address - Country:US
Mailing Address - Phone:330-375-0000
Mailing Address - Fax:330-375-0002
Practice Address - Street 1:1655 W MARKET ST STE L
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7021
Practice Address - Country:US
Practice Address - Phone:330-375-0000
Practice Address - Fax:330-375-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0297834Medicaid
OHG73220Medicare UPIN
OH0297834Medicaid