Provider Demographics
NPI:1174522510
Name:MKPARU, FIDELIS OKECHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:FIDELIS
Middle Name:OKECHUKWU
Last Name:MKPARU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2565 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5058
Mailing Address - Country:US
Mailing Address - Phone:330-823-0894
Mailing Address - Fax:330-823-4871
Practice Address - Street 1:2565 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5058
Practice Address - Country:US
Practice Address - Phone:330-823-0894
Practice Address - Fax:330-823-4871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067680M207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0186301Medicaid
OH0186301Medicaid
D95733Medicare UPIN