Healthcare Provider Details

I. General information

NPI: 1700848116
Provider Name (Legal Business Name): OSEHOTUE OKOJIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 ROSS AVE STE 150
DALLAS TX
75204-5245
US

IV. Provider business mailing address

3825 ROSS AVE STE 150
DALLAS TX
75204-5245
US

V. Phone/Fax

Practice location:
  • Phone: 214-515-9646
  • Fax: 214-515-9654
Mailing address:
  • Phone: 214-515-9646
  • Fax: 214-515-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN0329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: