Healthcare Provider Details

I. General information

NPI: 1912144403
Provider Name (Legal Business Name): OKWUDILI NNAJI M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

4777 N DIVERSEY BLVD
WHITEFISH BAY WI
53211-1012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2848
  • Fax:
Mailing address:
  • Phone: 718-809-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number273307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: