Healthcare Provider Details

I. General information

NPI: 1699979534
Provider Name (Legal Business Name): CHUKWUKA C OKAFOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 S FLORIDA AVE
LAKELAND FL
33813-2501
US

IV. Provider business mailing address

5050 S FLORIDA AVE
LAKELAND FL
33813-2501
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-3030
  • Fax: 863-688-4430
Mailing address:
  • Phone: 863-688-3030
  • Fax: 863-688-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD429548
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMT184380
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME 104463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: