Provider Demographics
NPI:1639246705
Name:OPARAECHE, NDUDI OKECHUKWU (MD)
Entity Type:Individual
Prefix:
First Name:NDUDI
Middle Name:OKECHUKWU
Last Name:OPARAECHE
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 1:9570 S KINGSTON CT STE 220
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6004
Mailing Address - Country:US
Mailing Address - Phone:303-515-2912
Mailing Address - Fax:303-957-5954
Practice Address - Street 1:9570 S KINGSTON CT STE 220
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-6004
Practice Address - Country:US
Practice Address - Phone:303-515-2912
Practice Address - Fax:303-957-5954
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43807207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01239201Medicaid
CO811029OtherMEDICARE PTAN
COC28591Medicare PIN
I00456Medicare UPIN