Healthcare Provider Details

I. General information

NPI: 1528642618
Provider Name (Legal Business Name): EMEKA S OKWUDILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 2ND ST
LANGDON ND
58249-2407
US

IV. Provider business mailing address

UCONN SCHOOL OF MEDICINE-GRADUATE MEDICAL EDUCATION 263 FARMINGTON AVENUE -LM068
FARMINGTON CT
06030-1921
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-6120
  • Fax: 701-256-6156
Mailing address:
  • Phone: 860-679-2147
  • Fax: 860-679-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20520
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: