Healthcare Provider Details

I. General information

NPI: 1053591164
Provider Name (Legal Business Name): CHIJIOKE D. UKOHA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N GALLOWAY AVE SUITE 100
MESQUITE TX
75149-2299
US

IV. Provider business mailing address

306 STONEMEADE WAY
COPPELL TX
75019-2679
US

V. Phone/Fax

Practice location:
  • Phone: 972-279-1700
  • Fax: 972-279-1102
Mailing address:
  • Phone: 972-279-1700
  • Fax: 972-279-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ8405
License Number StateTX

VIII. Authorized Official

Name: DR. CHIJIOKE DAVID UKOHA
Title or Position: PHYSICIAN
Credential: MD
Phone: 972-279-1700