=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700479987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELEMEDICO PHYSICIANS PULMONARY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2021
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 BOLIVAR ST
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65101-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-386-7744
-----------------------------------------------------
Fax | 847-881-0838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 W FRONTAGE RD STE 3700
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-227-3606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER/OWNER
-----------------------------------------------------
Name | JOEL C OKNER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 866-227-3606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------