MEDICARE: DR. OBINNA CHUKWUOCHA D.O.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	L9145	TX

General Provider Information

NPI Number	:	1316997455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBINNA CHUKWUOCHA D.O.

Provider Business Mailing Address
First Line	:	5400 W PLANO PKWY
Second Line	:	SUITE 230
City	:	PLANO
State	:	TX
Zip	:	75093-4852
Country	:	US
Telephone Number	:	972-818-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 W PLANO PKWY
Second Line	:	SUITE 230
City	:	PLANO
State	:	TX
Zip	:	75093-4852
Country	:	US
Telephone Number	:	972-818-8800
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/30/2011

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