Provider Demographics
NPI:1235331224
Name:OKOLIE, COLLINS (MD)
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:
Last Name:OKOLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2055
Mailing Address - Country:US
Mailing Address - Phone:740-775-8045
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159 STE 150
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7833
Practice Address - Country:US
Practice Address - Phone:740-779-4700
Practice Address - Fax:740-779-4798
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35094366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2996478Medicaid
OH2996478Medicaid