MEDICARE: DR. CHUKA GODWIN ENEBELI M.D

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	019299	PR
2	208D00000X	General Practice Physician	ACN979	FL
3	208D00000X	General Practice Physician	019299	PR
4	261QP3300X	Pain Clinic/Center	PMC1840	FL
5	208VP0000X	Pain Medicine Physician	ACN929	FL

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	:	1356705677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUKA GODWIN ENEBELI M.D

Provider Business Mailing Address
First Line	:	6905 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6829
Country	:	US
Telephone Number	:	305-731-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	6905 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6829
Country	:	US
Telephone Number	:	407-237-0648
Fax Number	:

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

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	08/02/2024

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Directions to “ DR. CHUKA GODWIN ENEBELI M.D” Practice Location

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