Healthcare Provider Details

I. General information

NPI: 1003835299
Provider Name (Legal Business Name): PATRICK IKEMEFUNA OKOLO III MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER ST FL 2
ROCHESTER NY
14621
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4136
  • Fax: 585-922-5761
Mailing address:
  • Phone: 585-922-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0046334
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number286049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: