Provider Demographics
NPI:1396302246
Name:AKAMIRO, KELECHI UGOCHI (MD)
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:UGOCHI
Last Name:AKAMIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:7566 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4333
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-256-1400
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330804207Q00000X, 207QS0010X
GA1396302246207Q00000X
GA10950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty