Healthcare Provider Details

I. General information

NPI: 1205288313
Provider Name (Legal Business Name): IFEOMA CHIAMAKA OGBUKA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

PO BOX 743129
ATLANTA GA
30374-3129
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-3667
  • Fax:
Mailing address:
  • Phone: 561-299-3667
  • Fax: 561-299-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58364
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME150142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: