Provider Demographics
NPI:1245341379
Name:UKAH, CELESTINE (MD)
Entity type:Individual
Prefix:DR
First Name:CELESTINE
Middle Name:
Last Name:UKAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4320
Mailing Address - Country:US
Mailing Address - Phone:352-508-5407
Mailing Address - Fax:877-535-4708
Practice Address - Street 1:9057 LAUREL RIDGE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9108
Practice Address - Country:US
Practice Address - Phone:352-267-7547
Practice Address - Fax:352-385-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86882207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81834OtherBLUE CROSS BLUE SHIELD
FL268964200Medicaid
FLH11928Medicare UPIN
FL268964200Medicaid