Provider Demographics
NPI:1356705677
Name:ENEBELI, CHUKA GODWIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHUKA
Middle Name:GODWIN
Last Name:ENEBELI
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 1:6905 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6829
Mailing Address - Country:US
Mailing Address - Phone:305-731-1144
Mailing Address - Fax:
Practice Address - Street 1:6905 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6829
Practice Address - Country:US
Practice Address - Phone:407-237-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019299207Q00000X, 208D00000X
FLACN979208D00000X
FLPMC1840261QP3300X
FLACN929208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain