Healthcare Provider Details

I. General information

NPI: 1437188125
Provider Name (Legal Business Name): MARTIN ONYELO OKONKWO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE 32ND AVE SUITE 101
OCALA FL
34471-5597
US

IV. Provider business mailing address

1800 SE 32ND AVE SUITE 101
OCALA FL
34471-5597
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-9988
  • Fax: 352-867-9921
Mailing address:
  • Phone: 352-867-9988
  • Fax: 352-867-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83433
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME83433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: