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General NPI Number Information
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NPI Number | 1790761500
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Entity Type | Individual
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Provider Name | UKONU EJIE MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 104 LACOSTA LN SUITE 120
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-8159
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Country | US
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Telephone | 386-274-1966
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Fax | 386-274-1964
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Provider Business Mailing Address
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Address Line | 104 LACOSTA LN SUITE 120
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-8159
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Country | US
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Telephone | 386-274-1966
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Fax | 386-274-1964
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME86706
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License Number State | FL
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