Healthcare Provider Details

I. General information

NPI: 1962667725
Provider Name (Legal Business Name): KELECHI CHIMA OKOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

IV. Provider business mailing address

PO BOX 1506
KELLER TX
76244-1506
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-5950
  • Fax:
Mailing address:
  • Phone: 214-947-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-093016
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.093016
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP8965
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.011250
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP8965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: