Healthcare Provider Details

I. General information

NPI: 1235310491
Provider Name (Legal Business Name): NKEMAKONAM I OKPOKWASILI D.O, M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 05/28/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG HESSEN CMR 470 BOX 8966
APO AE
09165
US

IV. Provider business mailing address

FORT GEORGE G. MEADE MEDDAC 2480 LLEWELLYN AVE
FORT MEADE MD
20755
US

V. Phone/Fax

Practice location:
  • Phone: 833-853-1392
  • Fax:
Mailing address:
  • Phone: 301-677-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101017536
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: