MEDICARE: EKOKOBE FONKEM DO

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	2084N0400X	Neurology Physician	OS024604C	PA
2	2084N0400X	Neurology Physician	81368	WI
3	2084N0400X	Neurology Physician	011473	AZ

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

General Provider Information

NPI Number	:	1538359534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EKOKOBE FONKEM DO

Provider Business Mailing Address
First Line	:	925 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006
Country	:	US
Telephone Number	:	480-256-6444
Fax Number	:	480-256-3682

Provider Business Practice Location Address
First Line	:	925 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006
Country	:	US
Telephone Number	:	480-256-6444
Fax Number	:	480-256-3682

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	01/23/2026

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