Healthcare Provider Details

I. General information

NPI: 1689994220
Provider Name (Legal Business Name): CHIOMA OKEAFOR TORRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD STE 405
EAST LANSING MI
48823-6819
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-8600
  • Fax: 517-884-8650
Mailing address:
  • Phone: 517-364-5440
  • Fax: 517-364-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2013-0718
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301106453
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number4301106453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: