Healthcare Provider Details

I. General information

NPI: 1619942315
Provider Name (Legal Business Name): VICTOR KYLE OKWIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE SHADYSIDE MEDICAL BUILDING, SUITE 610
PITTSBURGH PA
15232-1300
US

IV. Provider business mailing address

5200 CENTRE AVE SHADYSIDE MEDICAL BUILDING, SUITE 610
PITTSBURGH PA
15232-1300
US

V. Phone/Fax

Practice location:
  • Phone: 412-383-1650
  • Fax:
Mailing address:
  • Phone: 412-383-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD067041L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: