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NPI Code Detail

MEDICARE: OKEZIE WACHUKU

MEDICARE: OKEZIE WACHUKU
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
1261QP2000XPhysical Therapy Clinic/Center
2261QM2800XMethadone Clinic
32083X0100XOccupational Medicine Physician
4261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
5207QA0401XAddiction Medicine (Family Medicine) Physician
6207VG0400XGynecology Physician
7208VP0000XPain Medicine Physician
82083B0002XObesity Medicine (Preventive Medicine) Physician
92084P0800XPsychiatry Physician
10163WA0400XAddiction (Substance Use Disorder) Registered Nurse
11172V00000XCommunity Health Worker
12101Y00000XCounselor
13133N00000XNutritionist
14207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1285975227
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKEZIE WACHUKU
Provider Business Mailing Address
First Line : 8904 WOODWARD AVE # 104
Second Line :
City : DETROIT
State : MI
Zip : 48202-1821
Country : US
Telephone Number : 586-339-6101
Fax Number :
Provider Business Practice Location Address
First Line : 8904 WOODWARD AVE # 104
Second Line :
City : DETROIT
State : MI
Zip : 48202-1821
Country : US
Telephone Number : 586-339-6101
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. OKEZIE WACHUKU
Credential : M.B.A
Telephone Number : 586-339-6101
Provider Enumeration Date : 03/14/2013
Last Update Date : 05/06/2016

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Directions to “OKEZIE WACHUKU ” Practice Location

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