Healthcare Provider Details

I. General information

NPI: 1376391763
Provider Name (Legal Business Name): CYNTHIA OGECHI OKOLIE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 09/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST. ANTOINE
DETROIT MI
48201
US

IV. Provider business mailing address

269 WALKER ST PMB #601
DETROIT MI
48207
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-4342
  • Fax:
Mailing address:
  • Phone: 647-514-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: