Healthcare Provider Details

I. General information

NPI: 1528756616
Provider Name (Legal Business Name): COLUMBA CHUKWUBUIKEM CHUKWUKA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W LINCOLN WAY
JEFFERSON IA
50129-1685
US

IV. Provider business mailing address

1000 W LINCOLN WAY
JEFFERSON IA
50129-1685
US

V. Phone/Fax

Practice location:
  • Phone: 515-386-2114
  • Fax: 515-386-8899
Mailing address:
  • Phone: 515-386-2114
  • Fax: 515-386-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD56627
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: