Provider Demographics
NPI:1992752018
Name:ONUNKWO, CHIEDU CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHIEDU
Middle Name:CHARLES
Last Name:ONUNKWO
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:621 MEMORIAL DR STE 624
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1063
Practice Address - Country:US
Practice Address - Phone:574-647-8177
Practice Address - Fax:574-647-8536
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060521A207R00000X, 207RI0200X
WI48049207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000636045Medicare PIN
000036045Medicare PIN
I44388Medicare UPIN
P00359986Medicare PIN
DE1721Medicare PIN