MEDICARE: NELSON CHUKWUEMEKA OKOH MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	36167998	IL

General Provider Information

NPI Number	:	1346810660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON CHUKWUEMEKA OKOH MD

Provider Business Mailing Address
First Line	:	1503 JUNE BUG
Second Line	:
City	:	CARTERVILLE
State	:	IL
Zip	:	62918-2506
Country	:	US
Telephone Number	:	973-444-7184
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 HIGHWAY 37 W
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-6423
Country	:	US
Telephone Number	:	732-557-2604
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	05/13/2026

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