Provider Demographics
NPI:1063622850
Name:ETUFUGH, CHUKWUEMEKA NWANKIRE (MD)
Entity type:Individual
Prefix:DR
First Name:CHUKWUEMEKA
Middle Name:NWANKIRE
Last Name:ETUFUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5702
Mailing Address - Country:US
Mailing Address - Phone:646-594-6792
Mailing Address - Fax:
Practice Address - Street 1:1001 BUCKINGHAM RD STE 200
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:469-776-8990
Practice Address - Fax:469-776-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026179390200000X
TXN6285207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program