Provider Demographics
NPI:1639409790
Name:ONYEKURU, CHRISTIAN U
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:U
Last Name:ONYEKURU
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 1:2521 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6527
Mailing Address - Country:US
Mailing Address - Phone:405-996-7914
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2521 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6527
Practice Address - Country:US
Practice Address - Phone:405-996-7914
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120060AMedicaid