Provider Demographics
NPI:1689994220
Name:TORRES, CHIOMA OKEAFOR (MD)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:OKEAFOR
Last Name:TORRES
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 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-5440
Mailing Address - Fax:517-364-5409
Practice Address - Street 1:4660 S HAGADORN RD STE 405
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6819
Practice Address - Country:US
Practice Address - Phone:517-884-8600
Practice Address - Fax:517-884-8650
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0718208000000X
MI4301106453208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689994220Medicaid
MI0C36092298Medicare PIN