MEDICARE: BONAVENTURE C. OKORO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35-07-1648-O	OH
2	207R00000X	Internal Medicine Physician	35.071648	OH
3	208M00000X	Hospitalist Physician	35.071648	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5619197341A13	OTHER	OH	BLUECROSS BLUESHIELD
3	0824987	OTHER	OH	MCR (AUC)
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043280563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONAVENTURE C. OKORO MD

Provider Business Mailing Address
First Line	:	36115 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1216
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

Provider Business Practice Location Address
First Line	:	5542 AIRPORT HWY
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7304
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/21/2026

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Directions to “ BONAVENTURE C. OKORO MD” Practice Location

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