Provider Demographics
NPI:1477245322
Name:UKACHUKWU, CRYSTAL CHISOM (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHISOM
Last Name:UKACHUKWU
Suffix:
Gender:F
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:DEPARTMENT OF SURGERY 3601 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8312
Mailing Address - Country:US
Mailing Address - Phone:806-743-2370
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF SURGERY 3601 4TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8312
Practice Address - Country:US
Practice Address - Phone:806-743-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program