Healthcare Provider Details

I. General information

NPI: 1770752891
Provider Name (Legal Business Name): KENE TERENCE UGOKWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PARMALEE AVE SUITE 510
YOUNGSTOWN OH
44510-1716
US

IV. Provider business mailing address

540 PARMALEE AVE STE 510
YOUNGSTOWN OH
44510-1716
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1928
  • Fax: 330-744-2110
Mailing address:
  • Phone: 330-743-1928
  • Fax: 330-744-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number52597
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.091867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: