MEDICARE: OKEY NWOKOLO M.D.

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	19613	OK

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	:	1821052762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKEY NWOKOLO M.D.

Provider Business Mailing Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-0529
Fax Number	:	405-235-2832

Provider Business Practice Location Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-0529
Fax Number	:	405-235-2832

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/10/2012

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