Provider Demographics
NPI:1013109081
Name:CHUKWUANI, VIVIAN A (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:A
Last Name:CHUKWUANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:A
Other - Last Name:AGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2550 SOM CENTER RD # WH20
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9655
Mailing Address - Country:US
Mailing Address - Phone:440-943-2500
Mailing Address - Fax:440-516-8280
Practice Address - Street 1:2550 SOM CENTER RD # WH20
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9655
Practice Address - Country:US
Practice Address - Phone:440-943-2500
Practice Address - Fax:440-516-8280
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine