MEDICARE: OKEY WEIGHT MANAGEMENT CLINIC 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	261Q00000X	Clinic/Center	19613	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19613	OTHER	OK	LICENSE

General Provider Information

NPI Number	:	1659737799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKEY WEIGHT MANAGEMENT CLINIC PC

Provider Business Mailing Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-1414
Fax Number	:	405-605-5315

Provider Business Practice Location Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-1414
Fax Number	:	405-605-5315

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OKEY NWOKOLO
Credential	:	MD
Telephone Number	:	405-232-1414

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	04/25/2016

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