Provider Demographics
NPI:1275672099
Name:EZEIHUAKU, CHRISTOPHER CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHUKWUEMEKA
Last Name:EZEIHUAKU
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 1:203 LONGCREEK PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7138
Mailing Address - Country:US
Mailing Address - Phone:803-708-8856
Mailing Address - Fax:
Practice Address - Street 1:203 LONGCREEK PLANTATION DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7138
Practice Address - Country:US
Practice Address - Phone:803-708-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC287987Medicaid