Provider Demographics
NPI:1598964967
Name:UMEOZULU, VIVIAN CHINYERE (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:CHINYERE
Last Name:UMEOZULU
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 1:3601 SW 160TH AVE
Mailing Address - Street 2:SUITE #250
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6308
Mailing Address - Country:US
Mailing Address - Phone:305-866-9951
Mailing Address - Fax:877-284-8933
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242135207R00000X
MDD0067311207R00000X
DCMD037599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00759524OtherMEDICARE RAILROAD
MD4183444 00Medicaid
MDP00759526OtherMEDICARE RAILROAD
MDP00759526OtherMEDICARE RAILROAD
MD161699ZBLJMedicare PIN