Provider Demographics
NPI:1952612392
Name:ONUNKWO, VIVIAN U (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:U
Last Name:ONUNKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22818 OLD US 20
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9150
Mailing Address - Country:US
Mailing Address - Phone:574-389-1231
Mailing Address - Fax:
Practice Address - Street 1:22818 OLD US 20
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9150
Practice Address - Country:US
Practice Address - Phone:574-389-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011138972083X0100X
IN01078860A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952612392Medicaid