Healthcare Provider Details

I. General information

NPI: 1316107444
Provider Name (Legal Business Name): STANLEY E OKOSUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 402-328-8833
  • Fax: 402-328-2921
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25144
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25144
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: