Healthcare Provider Details

I. General information

NPI: 1275630295
Provider Name (Legal Business Name): CHUKWUMA UKATA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VILLAGE CT
GARNER NC
27529-3600
US

IV. Provider business mailing address

516 VILLAGE CT
GARNER NC
27529-3600
US

V. Phone/Fax

Practice location:
  • Phone: 919-661-4150
  • Fax: 919-779-8708
Mailing address:
  • Phone: 919-661-4150
  • Fax: 919-779-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number487
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: