Healthcare Provider Details

I. General information

NPI: 1528372729
Provider Name (Legal Business Name): DR. EKENE IFEANYI OKOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UNIVERSITY BLVD
ROUND ROCK TX
78665-1032
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-509-0100
  • Fax:
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN5920
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN5920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: