Basic Information
| Provider Information | |||||||||
| NPI: | 1912047382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IKPEAZU | ||||||||
| FirstName: | OLUNWA | ||||||||
| MiddleName: | CHISARA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6944 NW 126TH AVE | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330761964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545792242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9120A WILES RD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330671993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543410074 | ||||||||
| FaxNumber: | 9543453474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME 100885 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000633700 | 05 | FL | MEDICAID | 3820581 | 05 | TN | MEDICAID |