Healthcare Provider Details

I. General information

NPI: 1417650425
Provider Name (Legal Business Name): LINDA KOSISOCHUKWU CHUDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA KOSISOCHUKWU EPUNDU

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 FLOWOOD DR STE E
FLOWOOD MS
39232-9019
US

IV. Provider business mailing address

12920 OAKDALE ST
EASTVALE CA
92880-8505
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-5700
  • Fax: 601-815-5795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT-4894
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: