=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528642618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMEKA S OKWUDILI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2021
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 2ND ST
-----------------------------------------------------
City | LANGDON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58249-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-256-6120
-----------------------------------------------------
Fax | 701-256-6156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UCONN SCHOOL OF MEDICINE-GRADUATE MEDICAL EDUCATION 263 FARMINGTON AVENUE -LM068
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030-1921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-679-2147
-----------------------------------------------------
Fax | 860-679-4684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20520
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------