Healthcare Provider Details

I. General information

NPI: 1669731741
Provider Name (Legal Business Name): CHIBUIKE CHIMDIYA ANOKWUTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S HUDSON AVE
AURORA MO
65605-2362
US

IV. Provider business mailing address

550 S HUDSON AVE
AURORA MO
65605-2362
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-5176
  • Fax:
Mailing address:
  • Phone: 417-678-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59060
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13580
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020038633
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number40226
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: