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General NPI Number Information
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NPI Number | 1609167592
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Entity Type | Organization
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Legal Business Name | SPINE INSTITUTE OF CENTRAL FLORIDA
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 1301 GRASSLANDS BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-5401
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Country | US
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Telephone | 863-688-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 GRASSLANDS BOULVARD
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City | LAKELAND
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State | FL
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Zip | 33803-5401
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Country | US
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Telephone | 863-688-3030
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHUKWUKA C OKAFOR
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Credential | M.D. , M.B.A.
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Telephone | 863-688-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME104463
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License Number State | FL
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