Provider Demographics
NPI:1568901734
Name:EZEKAKPU, ELOCHUKWU
Entity Type:Individual
Prefix:
First Name:ELOCHUKWU
Middle Name:
Last Name:EZEKAKPU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 PINEORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1451
Mailing Address - Country:US
Mailing Address - Phone:615-569-5920
Mailing Address - Fax:
Practice Address - Street 1:4004 PINEORCHARD PL
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1451
Practice Address - Country:US
Practice Address - Phone:615-569-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ0-707-255-6207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine