Provider Demographics
NPI:1467912865
Name:OKORONKWO, OLUREMI OMOTAYO (MD)
Entity Type:Individual
Prefix:
First Name:OLUREMI
Middle Name:OMOTAYO
Last Name:OKORONKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD STE 410B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3000
Mailing Address - Country:US
Mailing Address - Phone:504-883-3770
Mailing Address - Fax:504-883-3711
Practice Address - Street 1:4228 HOUMA BLVD STE 410B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-883-3770
Practice Address - Fax:504-883-3711
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA336066207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program