Healthcare Provider Details

I. General information

NPI: 1255835138
Provider Name (Legal Business Name): VIVIAN ONYINYECHUKWUKA CHUKWURAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 TEXAS AVE STE 3061
ALEXANDRIA LA
71301-3903
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-2232
  • Fax: 318-442-9940
Mailing address:
  • Phone: 785-623-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME154238
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number345830
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-50047
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: