Healthcare Provider Details

I. General information

NPI: 1265766992
Provider Name (Legal Business Name): UCHENNA CHUKWURAH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE STE 3
ALBUQUERQUE NM
87102-2623
US

IV. Provider business mailing address

717 ENCINO PL NE STE 3
ALBUQUERQUE NM
87102-2623
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1591
  • Fax: 505-213-0091
Mailing address:
  • Phone: 505-717-1591
  • Fax: 505-213-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002335
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number343
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: