Provider Demographics
NPI:1053591164
Name:CHIJIOKE D. UKOHA MD PA
Entity type:Organization
Organization Name:CHIJIOKE D. UKOHA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIJIOKE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:UKOHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-279-1700
Mailing Address - Street 1:306 STONEMEADE WAY
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2679
Mailing Address - Country:US
Mailing Address - Phone:972-279-1700
Mailing Address - Fax:972-279-1102
Practice Address - Street 1:1800 N GALLOWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2299
Practice Address - Country:US
Practice Address - Phone:972-279-1700
Practice Address - Fax:972-279-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132062409Medicaid
F91382Medicare UPIN
00194TMedicare PIN