Provider Demographics
NPI:1518349182
Name:OKAFOR, NICOLA CHAUNTAY (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:CHAUNTAY
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:CHAUNTAY
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25304 SHIAWASSEE CIR APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3852
Mailing Address - Country:US
Mailing Address - Phone:313-433-3554
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-849-3441
Practice Address - Fax:248-849-5389
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine