Basic Information
| Provider Information | |||||||||
| NPI: | 1164954566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NDUKWE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHUKWUEMEKA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 185 S ORANGE AVE # MSBF-603 | ||||||||
| Address2: | P.O. BOX 1709 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739720740 | ||||||||
| FaxNumber: | 9739721019 | ||||||||
| Practice Location | |||||||||
| Address1: | 38600 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935514483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613825000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 390200000 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 207L00000X | A172134 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 390200000 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.