Healthcare Provider Details

I. General information

NPI: 1679001168
Provider Name (Legal Business Name): OKKY OEI MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N 33RD AVE STE 200
PHOENIX AZ
85009-1445
US

IV. Provider business mailing address

PO BOX 52022
PHOENIX AZ
85072-2022
US

V. Phone/Fax

Practice location:
  • Phone: 602-415-1111
  • Fax: 602-415-1417
Mailing address:
  • Phone: 602-431-1152
  • Fax: 602-431-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13583
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number13583
License Number StateAZ

VIII. Authorized Official

Name: KIRSTEN A SORENSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-431-1152