Healthcare Provider Details

I. General information

NPI: 1720298136
Provider Name (Legal Business Name): BLESSING N. OKORONKWO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLESSING N. OKOLI M.D.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29001 HARPER AVE
SAINT CLAIR SHORES MI
48081-2711
US

IV. Provider business mailing address

29001 HARPER AVE
SAINT CLAIR SHORES MI
48081-2711
US

V. Phone/Fax

Practice location:
  • Phone: 586-778-0664
  • Fax: 586-778-0396
Mailing address:
  • Phone: 586-778-0664
  • Fax: 586-778-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301084051
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301084051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: