Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | ME128479 | FL |
NPI | 1548571888 |
---|---|
Provider Name | Chiedozie Mkpolulu |
First Address | Leesburg, FL 34748-5287 |
Second Address | Leesburg, FL 34748-7601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 11/07/2016 |