Healthcare Provider Details

I. General information

NPI: 1689543985
Provider Name (Legal Business Name): MR. PAUL OKONKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GREEN RD STE 307
SOUTH EUCLID OH
44121-3976
US

IV. Provider business mailing address

1414 S GREEN RD STE 307
SOUTH EUCLID OH
44121-3976
US

V. Phone/Fax

Practice location:
  • Phone: 216-343-0712
  • Fax: 216-927-4879
Mailing address:
  • Phone: 216-343-0712
  • Fax: 216-927-4879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: