Healthcare Provider Details

I. General information

NPI: 1285438259
Provider Name (Legal Business Name): EJIKEME UZOCHUKWUCHINEDU ODUNUKWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ELIZABETH'S BLVD. SUITE 4000
O'FALLON IL
62269
US

IV. Provider business mailing address

3 SAINT ELIZABETH'S BLVD. SUITE 4000
O'FALLON IL
62269
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7880
  • Fax:
Mailing address:
  • Phone: 618-233-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: