Healthcare Provider Details

I. General information

NPI: 1770044539
Provider Name (Legal Business Name): RAYMOND OKEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD RM M260
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

1402 S GRAND BLVD RM M260
SAINT LOUIS MO
63104-1004
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8317
  • Fax: 314-268-5466
Mailing address:
  • Phone: 314-577-8317
  • Fax: 314-268-5466

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: