Provider Demographics
NPI:1275630295
Name:UKATA, CHUKWUMA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHUKWUMA
Middle Name:
Last Name:UKATA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3600
Mailing Address - Country:US
Mailing Address - Phone:919-661-4150
Mailing Address - Fax:919-779-8708
Practice Address - Street 1:516 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3600
Practice Address - Country:US
Practice Address - Phone:919-661-4150
Practice Address - Fax:919-779-8708
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC487213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89046HIMedicaid
NCV00143Medicare UPIN
NC89046HIMedicaid