MEDICARE: NDIDIBUIKE N UKWE 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	208000000X	Pediatrics Physician	E-6662	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548572027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NDIDIBUIKE N UKWE MD

Provider Business Mailing Address
First Line	:	7303 ROGERS AVE
Second Line	:	SUITE 200
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4165
Country	:	US
Telephone Number	:	479-314-4810
Fax Number	:

Provider Business Practice Location Address
First Line	:	7303 ROGERS AVE
Second Line	:	SUITE 200
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4165
Country	:	US
Telephone Number	:	479-314-4810
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	10/08/2014

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Directions to “ NDIDIBUIKE N UKWE MD” Practice Location

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