Provider Demographics
NPI:1992778831
Name:ODUNUKWE, CHUKWUKADIBIA J (MD)
Entity type:Individual
Prefix:DR
First Name:CHUKWUKADIBIA
Middle Name:J
Last Name:ODUNUKWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8679
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8679
Mailing Address - Country:US
Mailing Address - Phone:580-531-6465
Mailing Address - Fax:580-531-6426
Practice Address - Street 1:5604 SW LEE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9681
Practice Address - Country:US
Practice Address - Phone:580-531-6462
Practice Address - Fax:580-531-6426
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23714208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1123714Medicaid
OKP00769476OtherMEDICARE RAILROAD
OK1123714Medicaid