MEDICARE: CHARLES ONOCHIE OKEKE

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	174400000X	Specialist	27-1958431	AZ

General Provider Information

NPI Number	:	1053634097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ONOCHIE OKEKE

Provider Business Mailing Address
First Line	:	6241 N 27TH AVE
Second Line	:	APT 339
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1813
Country	:	US
Telephone Number	:	602-349-6163
Fax Number	:	602-606-2043

Provider Business Practice Location Address
First Line	:	6241 N 27TH AVE
Second Line	:	APT 339
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1813
Country	:	US
Telephone Number	:	602-349-6163
Fax Number	:	602-606-2043

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	04/08/2010

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Directions to “ CHARLES ONOCHIE OKEKE ” Practice Location

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