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General NPI Number Information
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NPI Number | 1366636235
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Entity Type | Individual
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Provider Name | ONYEKACHI U NWABUKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 6375 N WICKHAM RD STE 101
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City | MELBOURNE
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State | FL
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Zip | 32940-2013
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Country | US
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Telephone | 321-465-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST SUITE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01068622A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01068622A
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License Number State | IN
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