Provider Demographics
NPI:1699979534
Name:OKAFOR, CHUKWUKA C (MD)
Entity type:Individual
Prefix:
First Name:CHUKWUKA
Middle Name:C
Last Name:OKAFOR
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 1:5050 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2501
Mailing Address - Country:US
Mailing Address - Phone:863-688-3030
Mailing Address - Fax:863-688-4430
Practice Address - Street 1:5050 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2501
Practice Address - Country:US
Practice Address - Phone:863-688-3030
Practice Address - Fax:863-688-4430
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429548207X00000X
PAMT184380207X00000X
FLME 104463207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL328285OtherAVMED
FL145C8OtherBC/BS
FL8814356OtherAETNA
FL3200107OtherCIGNA
FL001188600Medicaid
FL3200107OtherCIGNA