Healthcare Provider Details

I. General information

NPI: 1144238213
Provider Name (Legal Business Name): CHRISTOPHER IKHAMATE UKIOMOGBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18585 NW 27TH AVE
OPA LOCKA FL
33056-3104
US

IV. Provider business mailing address

108 BELMONT DR
WEST PALM BEACH FL
33411-8272
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-3430
  • Fax: 305-620-0810
Mailing address:
  • Phone: 561-204-5514
  • Fax: 561-204-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0071980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: