Provider Demographics
NPI:1053573824
Name:MOLOKWU, CALEB OKAFOR (DO)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:OKAFOR
Last Name:MOLOKWU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1309
Mailing Address - Fax:937-522-8940
Practice Address - Street 1:2555 CREEKWOOD CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4056
Practice Address - Country:US
Practice Address - Phone:937-327-0552
Practice Address - Fax:937-327-0556
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34.009701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063410Medicaid
OHH087271Medicare PIN