Provider Demographics
NPI:1629332820
Name:ODUKWE ENU, CHIOMA N (DPM)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:N
Last Name:ODUKWE ENU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CHIOMA
Other - Middle Name:N
Other - Last Name:ODUKWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:83 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-787-3800
Mailing Address - Fax:203-787-0004
Practice Address - Street 1:83 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-787-3800
Practice Address - Fax:203-787-0004
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000932213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program