MEDICARE: ENOEMEM OKPOKPO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	OS17819	FL
2	207R00000X	Internal Medicine Physician	OS17819	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	WT139	OTHER	FL	HFMG

General Provider Information

NPI Number	:	1326508433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOEMEM OKPOKPO DO

Provider Business Mailing Address
First Line	:	12123 RUSTIC RIVER WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9536
Country	:	US
Telephone Number	:	954-305-6374
Fax Number	:

Provider Business Practice Location Address
First Line	:	12123 RUSTIC RIVER WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9536
Country	:	US
Telephone Number	:	954-305-6374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	01/12/2026

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Directions to “ ENOEMEM OKPOKPO DO” Practice Location

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