Healthcare Provider Details

I. General information

NPI: 1578528121
Provider Name (Legal Business Name): ZELDA IKULUMET OKIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MORELAND BLVD
WAUKESHA WI
53188-2428
US

IV. Provider business mailing address

515 W MORELAND BLVD
WAUKESHA WI
53188-2428
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-7575
  • Fax: 262-896-8079
Mailing address:
  • Phone: 262-548-7575
  • Fax: 262-896-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number42266
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: