Provider Demographics
NPI:1114931185
Name:OKADIGWE, CHUKUMA (MD)
Entity Type:Individual
Prefix:
First Name:CHUKUMA
Middle Name:
Last Name:OKADIGWE
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 1:191 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4701
Mailing Address - Country:US
Mailing Address - Phone:718-287-0505
Mailing Address - Fax:718-287-0462
Practice Address - Street 1:191 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4701
Practice Address - Country:US
Practice Address - Phone:718-287-0505
Practice Address - Fax:718-287-0462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00230328Medicaid
B12756Medicare UPIN
NY313141Medicare PIN