MEDICARE: DR. CHIBUZO ONYEZE UKAEGBU MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD 2008-0255	NM
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	MD2008-0255	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104011444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHIBUZO ONYEZE UKAEGBU MD, MPH

Provider Business Mailing Address
First Line	:	PO BOX 13969
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88013-3969
Country	:	US
Telephone Number	:
Fax Number	:	575-652-3213

Provider Business Practice Location Address
First Line	:	3885 FOOTHILLS RD
Second Line	:	SUITE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4672
Country	:	US
Telephone Number	:	575-556-9837
Fax Number	:	575-652-3213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	06/19/2018

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