Provider Demographics
NPI:1053634097
Name:OKEKE, CHARLES ONOCHIE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ONOCHIE
Last Name:OKEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:NGOZI
Other - Last Name:ALOZIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6241 N 27TH AVE
Mailing Address - Street 2:APT 339
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1813
Mailing Address - Country:US
Mailing Address - Phone:602-349-6163
Mailing Address - Fax:602-606-2043
Practice Address - Street 1:6241 N 27TH AVE
Practice Address - Street 2:APT 339
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1813
Practice Address - Country:US
Practice Address - Phone:602-349-6163
Practice Address - Fax:602-606-2043
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27-1958431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist