Individual
CHUKWUKA G AYETIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
605 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 796-9990
(352) 796-2226
Mailing address
5130 SUNFOREST DR STE 300, TAMPA, FL 33634-6327
(727) 824-0780
(813) 514-8891
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS17378
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110907100
—
FL
Enumeration date
04/26/2018
Last updated
03/07/2023
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