Healthcare Provider Details

I. General information

NPI: 1356705677
Provider Name (Legal Business Name): CHUKA GODWIN ENEBELI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 W COLONIAL DR
ORLANDO FL
32818-6829
US

IV. Provider business mailing address

6905 W COLONIAL DR
ORLANDO FL
32818-6829
US

V. Phone/Fax

Practice location:
  • Phone: 407-237-0648
  • Fax:
Mailing address:
  • Phone: 305-731-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019299
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN979
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number019299
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberPMC1840
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberACN929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: