Healthcare Provider Details

I. General information

NPI: 1356335178
Provider Name (Legal Business Name): CHUKWUMA M OKOROJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 CARE DR SUITE 102-103
TALLAHASSEE FL
32308-9814
US

IV. Provider business mailing address

2473 CARE DR SUITE 102-103
TALLAHASSEE FL
32308-9814
US

V. Phone/Fax

Practice location:
  • Phone: 850-302-6054
  • Fax: 850-320-6961
Mailing address:
  • Phone: 850-302-6054
  • Fax: 850-320-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA0752600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA0752600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 103799
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036106681
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2008016029
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME103799
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA0752600
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: