Healthcare Provider Details

I. General information

NPI: 1346793890
Provider Name (Legal Business Name): CHUKWUEMEKA OKABUONYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 LONG REACH DR APT 11202
SUGAR LAND TX
77478-4197
US

IV. Provider business mailing address

2323 LONG REACH DR APT 11202
SUGAR LAND TX
77478-4197
US

V. Phone/Fax

Practice location:
  • Phone: 773-430-6608
  • Fax:
Mailing address:
  • Phone: 773-430-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number117650
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number117650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: