Provider Demographics
NPI:1447078761
Name:EKEKWE, CHINEDUM
Entity type:Individual
Prefix:
First Name:CHINEDUM
Middle Name:
Last Name:EKEKWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHINEDUM
Other - Middle Name:
Other - Last Name:EKEKWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5740 NORTHWEST PKWY APT 1302
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2596
Mailing Address - Country:US
Mailing Address - Phone:409-791-0822
Mailing Address - Fax:
Practice Address - Street 1:5740 NORTHWEST PKWY APT 1302
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2596
Practice Address - Country:US
Practice Address - Phone:409-791-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker