Healthcare Provider Details

I. General information

NPI: 1962697250
Provider Name (Legal Business Name): MARTIN NNAEMEKA OKPALIKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 N MONROE ST
DECATUR IL
62526-3269
US

IV. Provider business mailing address

310 N COUNTRY CLUB CT
DECATUR IL
62521-2567
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-8000
  • Fax: 855-347-8363
Mailing address:
  • Phone: 217-876-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014-00844
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08308100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064107A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036120153
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036120153
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01064107A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: