Provider Demographics
NPI:1922022474
Name:OKONKWO, CHRIS NWACHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:NWACHUKWU
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 SE 25TH LOOP # 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6090
Mailing Address - Country:US
Mailing Address - Phone:352-671-1800
Mailing Address - Fax:352-671-1802
Practice Address - Street 1:1329 SE 25TH LOOP # 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6090
Practice Address - Country:US
Practice Address - Phone:352-671-1800
Practice Address - Fax:352-671-1802
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44639OtherBLUE CROSS BLUE SHIELD