Provider Demographics
NPI:1992497895
Name:OJUKWU, SOMTOCHUKWU GRANT (PA-C)
Entity type:Individual
Prefix:MR
First Name:SOMTOCHUKWU
Middle Name:GRANT
Last Name:OJUKWU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 N CALIFORNIA AVE UNIT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5877
Mailing Address - Country:US
Mailing Address - Phone:209-421-8605
Mailing Address - Fax:
Practice Address - Street 1:3240 N CALIFORNIA AVE UNIT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5877
Practice Address - Country:US
Practice Address - Phone:209-421-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program