Healthcare Provider Details

I. General information

NPI: 1467516757
Provider Name (Legal Business Name): UCHENNA CHRISTOPHER OGBUOKIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 S BROADWAY
SAINT LOUIS MO
63118-4601
US

IV. Provider business mailing address

12125 WOODCREST EXECUTIVE DR SUITE 220
SAINT LOUIS MO
63141-5001
US

V. Phone/Fax

Practice location:
  • Phone: 314-317-0600
  • Fax: 314-317-0606
Mailing address:
  • Phone: 314-317-0600
  • Fax: 314-317-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number2006025323
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2006025323
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: