Provider Demographics
NPI:1437188125
Name:OKONKWO, MARTIN ONYELO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ONYELO
Last Name:OKONKWO
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 1:1800 SE 32ND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5597
Mailing Address - Country:US
Mailing Address - Phone:352-867-9988
Mailing Address - Fax:352-867-9921
Practice Address - Street 1:1800 SE 32ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5597
Practice Address - Country:US
Practice Address - Phone:352-867-9988
Practice Address - Fax:352-867-9921
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83433208000000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263160100Medicaid