Healthcare Provider Details

I. General information

NPI: 1164954566
Provider Name (Legal Business Name): MICHAEL CHUKWUEMEKA NDUKWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

185 S ORANGE AVE # MSBF-603 P.O. BOX 1709
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-5000
  • Fax:
Mailing address:
  • Phone: 973-972-0740
  • Fax: 973-972-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number390200000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA172134
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number390200000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: