Healthcare Provider Details

I. General information

NPI: 1245341379
Provider Name (Legal Business Name): CELESTINE UKAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 LAUREL RIDGE DR
MOUNT DORA FL
32757-9108
US

IV. Provider business mailing address

1878 MAYO DR
TAVARES FL
32778-4320
US

V. Phone/Fax

Practice location:
  • Phone: 352-267-7547
  • Fax: 352-385-0966
Mailing address:
  • Phone: 352-508-5407
  • Fax: 877-535-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME86882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: