Provider Demographics
NPI:1265766992
Name:CHUKWURAH, UCHENNA (DPM)
Entity type:Individual
Prefix:DR
First Name:UCHENNA
Middle Name:
Last Name:CHUKWURAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE STE 3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2623
Mailing Address - Country:US
Mailing Address - Phone:505-717-1591
Mailing Address - Fax:505-213-0091
Practice Address - Street 1:717 ENCINO PL NE STE 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2623
Practice Address - Country:US
Practice Address - Phone:505-717-1591
Practice Address - Fax:505-213-0091
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002335213ES0103X
NM343213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF8031Medicaid
NMNMB2035Medicare PIN