Provider Demographics
NPI:1518557487
Name:OKOH, SAMSON OMOSHEWE
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:OMOSHEWE
Last Name:OKOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17843 TORRENCE AVE APT F
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0197
Mailing Address - Country:US
Mailing Address - Phone:773-941-2693
Mailing Address - Fax:
Practice Address - Street 1:17843 TORRENCE AVE APT F
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-0197
Practice Address - Country:US
Practice Address - Phone:773-941-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)