Healthcare Provider Details

I. General information

NPI: 1619264819
Provider Name (Legal Business Name): KENECHUKWU A CHUKWUANU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KENE A CHUKWUANU M.D.

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD #100371
GAINESVILLE FL
32610-0301
US

IV. Provider business mailing address

1600 SW ARCHER RD #100371
GAINESVILLE FL
32610-0301
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0301
  • Fax:
Mailing address:
  • Phone: 352-265-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME129240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: