Provider Demographics
NPI:1306008875
Name:OKEKE, NDIDI IFEOMA (MD)
Entity Type:Individual
Prefix:
First Name:NDIDI
Middle Name:IFEOMA
Last Name:OKEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NDIDI
Other - Middle Name:IFEOMA
Other - Last Name:NTUKOGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12064 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1139
Mailing Address - Country:US
Mailing Address - Phone:313-273-8372
Mailing Address - Fax:
Practice Address - Street 1:12064 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1139
Practice Address - Country:US
Practice Address - Phone:313-273-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090720103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)