MEDICARE: OKEY OKOLI, M.D., P.A.

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	207V00000X	Obstetrics & Gynecology Physician	L1418	TX

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

General Provider Information

NPI Number	:	1386829828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKEY OKOLI, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 691546
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-1546
Country	:	US
Telephone Number	:	210-333-8895
Fax Number	:	210-599-3693

Provider Business Practice Location Address
First Line	:	14100 NACOGDOCHES RD
Second Line	:	STE 140
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1903
Country	:	US
Telephone Number	:	210-333-8895
Fax Number	:	210-599-3693

Authorized Official
Title or Position	:	BILLING
Name	:	JOANN VEGA
Credential	:
Telephone Number	:	210-333-8895

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	02/04/2014

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