Provider Demographics
NPI:1124187240
Name:MPUKU, FELIX B (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:B
Last Name:MPUKU
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 1:3180 MAIN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-6322
Mailing Address - Fax:203-371-8930
Practice Address - Street 1:3180 MAIN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-6322
Practice Address - Fax:203-371-8930
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010027879CT05OtherANTHEM BCBS
25494OtherOXFORD
781070OtherCONNECTICARE
001569OtherHEALTHNET
CT1278795Medicaid
C59753Medicare UPIN