Healthcare Provider Details

I. General information

NPI: 1679569289
Provider Name (Legal Business Name): ENID A OKOKON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N MARTIN LUTHER KING DR MILWAUKEE HEALTH SERVICES, INC.
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

2555 N MARTIN LUTHER KING DR MILWAUKEE HEALTH SERVICES, INC.
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-8080
  • Fax: 414-562-8078
Mailing address:
  • Phone: 414-372-8080
  • Fax: 414-562-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: