Healthcare Provider Details

I. General information

NPI: 1801412218
Provider Name (Legal Business Name): MATTHEW OKEKE, M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

IV. Provider business mailing address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-0099
  • Fax: 702-778-7632
Mailing address:
  • Phone: 702-202-0099
  • Fax: 702-778-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW OKEKE
Title or Position: OWNER
Credential: MD
Phone: 702-202-0099