Provider Demographics
NPI:1467945642
Name:ADIGWEME, UGOCHUKWU CHIDOZIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:UGOCHUKWU
Middle Name:CHIDOZIE
Last Name:ADIGWEME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:UGO
Other - Middle Name:CHIDOZIE
Other - Last Name:ADIGWEME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:125 E PINE ST APT 1912
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3092
Mailing Address - Country:US
Mailing Address - Phone:904-521-2099
Mailing Address - Fax:
Practice Address - Street 1:985 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4010213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid