MEDICARE: DR. MICHAEL C UKAEGBU MD

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	207R00000X	Internal Medicine Physician	44152	KY
2	207R00000X	Internal Medicine Physician	ME117949	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	:	1427254283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C UKAEGBU MD

Provider Business Mailing Address
First Line	:	1465 W US HIGHWAY 90
Second Line	:	SUITE 100
City	:	LAKE CITY
State	:	FL
Zip	:	32055-6123
Country	:	US
Telephone Number	:	386-755-2268
Fax Number	:	386-466-1923

Provider Business Practice Location Address
First Line	:	221 SW STONEGATE TER STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3463
Country	:	US
Telephone Number	:	386-292-7744
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	10/02/2019

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