Healthcare Provider Details

I. General information

NPI: 1073877700
Provider Name (Legal Business Name): OLUBUKOLA ADUKE OKORO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 STOCKTON DR UNIT 6100
ALLEN TX
75013-6158
US

IV. Provider business mailing address

945 STOCKTON DR UNIT 6100
ALLEN TX
75013-6158
US

V. Phone/Fax

Practice location:
  • Phone: 972-390-7667
  • Fax: 972-390-1557
Mailing address:
  • Phone: 972-390-7667
  • Fax: 972-390-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ6407
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301101483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: