Provider Demographics
NPI:1497897128
Name:EMMANUEL OKECHUKWU MD PC
Entity Type:Organization
Organization Name:EMMANUEL OKECHUKWU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:OKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-210-2763
Mailing Address - Street 1:11870 TEVARE LN UNIT 2084
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6505
Mailing Address - Country:US
Mailing Address - Phone:702-210-2763
Mailing Address - Fax:
Practice Address - Street 1:11870 TEVARE LN UNIT 2084
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6505
Practice Address - Country:US
Practice Address - Phone:702-210-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty