Individual
CHUKA VICTOR IFEANYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1455 E BERT KOUN LOOP, #206, SHREVEPORT, LA 71105-5634
(318) 798-4464
(318) 798-4529
Mailing address
1455 E BERT KOUN LOOP, #206, SHREVEPORT, LA 71105-5634
(318) 798-4464
(318) 798-4529
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
206975
LA
207Y00000X
Otolaryngology Physician
R-8725
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2370146
—
LA
Enumeration date
06/19/2009
Last updated
12/11/2020
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