Provider Demographics
NPI:1104190735
Name:OKOLIE, ANGELA CHUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CHUDE
Last Name:OKOLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 DON WICKHAM DR
Mailing Address - Street 2:MP SL ADMIN
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1979
Mailing Address - Country:US
Mailing Address - Phone:352-536-8840
Mailing Address - Fax:352-536-8841
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:MP SL ADMIN
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-536-8840
Practice Address - Fax:352-536-8841
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 112128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME112128OtherMEDICAL LICENSE
FL014563800Medicaid
FLME112128OtherMEDICAL LICENSE