Provider Demographics
NPI:1356335178
Name:OKOROJI, CHUKWUMA M (MD)
Entity type:Individual
Prefix:DR
First Name:CHUKWUMA
Middle Name:M
Last Name:OKOROJI
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 1:2473 CARE DR
Mailing Address - Street 2:SUITE 102-103
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-9814
Mailing Address - Country:US
Mailing Address - Phone:850-302-6054
Mailing Address - Fax:850-320-6961
Practice Address - Street 1:2473 CARE DR
Practice Address - Street 2:SUITE 102-103
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-9814
Practice Address - Country:US
Practice Address - Phone:850-302-6054
Practice Address - Fax:850-320-6961
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0752600207P00000X, 207Q00000X, 208D00000X
FLME 103799207Q00000X
IL036106681207V00000X
MO2008016029207V00000X
FLME103799207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145LDOtherBCBS OF FLORIDA
NJ0041742Medicaid
FL001320500Medicaid
IL036106681Medicaid
FL145LDOtherBCBS OF FLORIDA
IL036106681Medicaid
NJI23174Medicare UPIN