Provider Demographics
NPI:1588058325
Name:MADUAGWU, OKOROAFOR NDUKA (MD)
Entity type:Individual
Prefix:
First Name:OKOROAFOR
Middle Name:NDUKA
Last Name:MADUAGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 S DOUGLAS RD
Mailing Address - Street 2:STE 308
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:813-900-8574
Mailing Address - Fax:
Practice Address - Street 1:135 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4609
Practice Address - Country:US
Practice Address - Phone:863-686-2728
Practice Address - Fax:863-686-6737
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19022208D00000X
FLACN 686208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice