Healthcare Provider Details

I. General information

NPI: 1144959917
Provider Name (Legal Business Name): OKELUE EDWARDS OKOBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 05/21/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH PLACE HIALEAH
MIAMI FL
33012
US

IV. Provider business mailing address

12218 APACHE TEARS CIR
LAUREL MD
20708-2847
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2500
  • Fax:
Mailing address:
  • Phone: 240-360-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberP115323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: