Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 17368 | FL |
Y | 2080P0202X | Pediatric Cardiologist | 25641 | MS |
NPI | 1275895559 |
---|---|
Provider Name | Dr. Onyekachukwu Jideofo Osakwe |
First Address | Jackson, MS 39216-4500 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 06/08/2018 |