=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528233178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 SE 32ND AVE SUITE 101
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-5597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-867-9988
-----------------------------------------------------
Fax | 352-867-9921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 SE 32ND AVE SUITE 101
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-5597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-867-9988
-----------------------------------------------------
Fax | 352-867-9921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. MARTIN ONYELO OKONKWO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-867-9988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME83433
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------