Provider Demographics
NPI:1861851214
Name:OJEMAYE, LUKACHUKWU (DPT)
Entity Type:Individual
Prefix:
First Name:LUKACHUKWU
Middle Name:
Last Name:OJEMAYE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 CREEKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5345
Mailing Address - Country:US
Mailing Address - Phone:469-534-3068
Mailing Address - Fax:
Practice Address - Street 1:6011 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5386
Practice Address - Country:US
Practice Address - Phone:214-648-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1268578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist