1639538127 NPI number — ANDREW CHUKWUMA MD

Table of content: ANDREW CHUKWUMA MD (NPI 1639538127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639538127 NPI number — ANDREW CHUKWUMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUKWUMA
Provider First Name:
ANDREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639538127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/22/2020
NPI Reactivation Date:
07/19/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 STANTON L. YOUNG BLVD
Provider Second Line Business Mailing Address:
ANDREWS ACADEMIC TOWER 6300
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-8001
Provider Business Mailing Address Fax Number:
405-271-1476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 STANTON L YOUNG BLVD
Provider Second Line Business Practice Location Address:
AAT 6300
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-5963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  43595 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com