Healthcare Provider Details

I. General information

NPI: 1518545425
Provider Name (Legal Business Name): KELECHI JOSEPH UJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KELECHI JOSEPH UJU MD

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

IV. Provider business mailing address

851 FIELDS DR APT 422B
BOWLING GREEN KY
42104-5362
US

V. Phone/Fax

Practice location:
  • Phone: 270-780-2680
  • Fax:
Mailing address:
  • Phone: 270-438-9106
  • 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: