Healthcare Provider Details

I. General information

NPI: 1871285403
Provider Name (Legal Business Name): JUSTIN-DAVID ELOCHUKWU OKORO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 06/21/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 615
DETROIT MI
48201-2022
US

IV. Provider business mailing address

4160 JOHN R ST STE 615
DETROIT MI
48201-2022
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4195
  • Fax: 313-993-8669
Mailing address:
  • Phone: 313-745-4195
  • Fax: 313-993-8669

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: