MEDICARE: EMMANUEL OKECHUKWU MD PC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497897128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL OKECHUKWU MD PC

Provider Business Mailing Address
First Line	:	11870 TEVARE LN UNIT 2084
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6505
Country	:	US
Telephone Number	:	702-210-2763
Fax Number	:

Provider Business Practice Location Address
First Line	:	11870 TEVARE LN UNIT 2084
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6505
Country	:	US
Telephone Number	:	702-210-2763
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EMMANUEL I OKECHUKWU
Credential	:	MD
Telephone Number	:	702-210-2763

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/15/2020

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