Provider Demographics
NPI:1477980894
Name:CHINYERE OKEKE MD LTD
Entity Type:Organization
Organization Name:CHINYERE OKEKE MD LTD
Other - Org Name:GRAND DESERT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-202-0099
Mailing Address - Street 1:PO BOX 400997
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0997
Mailing Address - Country:US
Mailing Address - Phone:702-202-0099
Mailing Address - Fax:702-778-7632
Practice Address - Street 1:2001 S RAINBOW BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2990
Practice Address - Country:US
Practice Address - Phone:702-202-0099
Practice Address - Fax:702-778-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1255562880Medicaid
NV1255562880OtherINDIVIDUAL NPI