Provider Demographics
NPI:1598483117
Name:OFIAELI, CHUKWUKANENE (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUKANENE
Middle Name:
Last Name:OFIAELI
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 1:14021 LAKE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3816
Mailing Address - Country:US
Mailing Address - Phone:781-502-2503
Mailing Address - Fax:
Practice Address - Street 1:2739 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-9701
Practice Address - Country:US
Practice Address - Phone:813-782-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022963208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty