MEDICARE: DR. CELESTINE UKAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME86882	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81834	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245341379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELESTINE UKAH MD

Provider Business Mailing Address
First Line	:	1878 MAYO DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-4320
Country	:	US
Telephone Number	:	352-508-5407
Fax Number	:	877-535-4708

Provider Business Practice Location Address
First Line	:	9057 LAUREL RIDGE DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9108
Country	:	US
Telephone Number	:	352-267-7547
Fax Number	:	352-385-0966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/31/2017

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