Provider Demographics
NPI:1912047382
Name:IKPEAZU, OLUNWA CHISARA (MD)
Entity type:Individual
Prefix:DR
First Name:OLUNWA
Middle Name:CHISARA
Last Name:IKPEAZU
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 1:6944 NW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1964
Mailing Address - Country:US
Mailing Address - Phone:954-579-2242
Mailing Address - Fax:
Practice Address - Street 1:9120A WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-1993
Practice Address - Country:US
Practice Address - Phone:954-341-0074
Practice Address - Fax:954-345-3474
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000633700Medicaid
TN3820581Medicaid
TNG87310Medicare UPIN
FL000633700Medicaid