Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 46539 | MN |
NPI | 1003143256 |
---|---|
Provider Name | Charles Okechukwu Dike |
First Address | Worthington, MN 56187-1008 |
Second Address | Worthington, MN 56187-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 09/11/2009 |