MEDICARE: DR. OKELUE EDWARDS OKOBI 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	261QM1300X	Multi-Specialty Clinic/Center	P115323	NY
2	207Q00000X	Family Medicine Physician	W2340	TX

General Provider Information

NPI Number	:	1144959917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OKELUE EDWARDS OKOBI MD

Provider Business Mailing Address
First Line	:	12218 APACHE TEARS CIR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2847
Country	:	US
Telephone Number	:	240-360-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 W 49TH PLACE
Second Line	:	HIALEAH
City	:	MIAMI
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-558-2500
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	03/12/2026

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