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General NPI Number Information
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NPI Number | 1992778831
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Entity Type | Individual
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Provider Name | CHUKWUKADIBIA J ODUNUKWE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 5604 SW LEE BLVD SUITE 210
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City | LAWTON
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State | OK
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Zip | 73505-9681
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Country | US
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Telephone | 580-531-6462
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Fax | 580-531-6426
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Provider Business Mailing Address
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Address Line | PO BOX 8679
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City | BELFAST
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State | ME
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Zip | 04915-8679
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Country | US
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Telephone | 580-531-6465
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Fax | 580-531-6426
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 23714
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License Number State | OK
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