Healthcare Provider Details

I. General information

NPI: 1629026455
Provider Name (Legal Business Name): CLEMENT U OKINEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 GOVERNORS DR SW
HUNTSVILLE AL
35801-5124
US

IV. Provider business mailing address

PO BOX 2705
HUNTSVILLE AL
35804-2705
US

V. Phone/Fax

Practice location:
  • Phone: 256-489-0489
  • Fax: 256-489-0506
Mailing address:
  • Phone: 256-341-2909
  • Fax: 256-973-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00023707
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: