Healthcare Provider Details

I. General information

NPI: 1992939805
Provider Name (Legal Business Name): OLUWAKEMI M EDOKPAYI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUWAKEMI M JOHNSON MD

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 A ST STE 200
LINCOLN NE
68510-4970
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8630
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number91742
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number75623
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC2959
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCP2260
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036133370
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: