Healthcare Provider Details

I. General information

NPI: 1275895559
Provider Name (Legal Business Name): ONYEKACHUKWU JIDEOFO OSAKWE MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1190 N STATE ST STE 200
JACKSON MS
39202-2413
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 601-965-6100
  • Fax: 601-965-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17368
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25641
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: