Healthcare Provider Details

I. General information

NPI: 1689747859
Provider Name (Legal Business Name): MARGARET IFEANYICHUKWU OKONKWO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 NE 1ST AVE
MIAMI FL
33137-3504
US

IV. Provider business mailing address

2731 ML KING JR BLVD
TUSCALOOSA AL
35401-5235
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-5437
  • Fax: 305-576-5120
Mailing address:
  • Phone: 205-349-3250
  • Fax: 205-752-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME82932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: