MRS. THEODORA CHUKWUDI (FNP) – Family Nurse Practitioner, NPI 1063005403

MRS. THEODORA CHUKWUDI (FNP) is a healthcare provider. based in Canton, Michigan. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. 4704249499 (MI). The NPI Number for MRS. THEODORA CHUKWUDI (FNP) is 1063005403

Main info

Female
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
MRS. THEODORA CHUKWUDI (FNP)
NPI
1063005403
Phone
(734) 981-3968
Address
45300 CHERRY HILL RD
Enumeration Date
17 February 2021
Last Update Date
17 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7342858282
Graduation Year
2015 (11 years ago)
PAC ID
5890961742
Group Practice PAC ID
7911995139
Professional Enrollment ID
I20210623002718
Address ID
MI481806394TA20500RDXX301
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

8,161 NURSE PRACTITIONER in MI

Provider Addresses for MRS. THEODORA CHUKWUDI (FNP)

  • 45300 CHERRY HILL RD

    CANTON, MI 481875073

    Phone: (734) 981-3968

    Type: Location

  • 7445 ALLEN RD STE 270

    ALLEN PARK, MI 481011963

    Phone: (313) 920-6546

    Fax: (313) 949-5793

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $103.

Total Amount is formed as General ($103) + Research ($0) + Ownership ($0) = $103.

Last reported payment date: 2024-10-03 • Largest payer in this snapshot: ITI, Inc. (d/b/a Intra-Cellular Therapies, Inc.) ($103).

Total Amount

$103

General + Research + Ownership

Payments

1

Total payment records

General Amount

$103

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-03

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-06-23

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210623002718INurse PractitionerMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48187)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7911995139View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for MRS. THEODORA CHUKWUDI (FNP)?
MRS. THEODORA CHUKWUDI (FNP) — NPI 1063005403 — is the standard way to identify this listing.
Is MRS. THEODORA CHUKWUDI (FNP) listed as active for patients and plans?
The listing shows MRS. THEODORA CHUKWUDI (FNP) as active in the NPI system.
What is MRS. THEODORA CHUKWUDI (FNP)'s specialty?
The listing groups MRS. THEODORA CHUKWUDI (FNP) with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What address line appears for MRS. THEODORA CHUKWUDI (FNP)?
MRS. THEODORA CHUKWUDI (FNP)'s geographic hint is Canton, Michigan in our summary view.
Is the information about MRS. THEODORA CHUKWUDI (FNP) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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