Provider Demographics
NPI:1558331520
Name:OKPALAOKA, OSITA E (MD)
Entity Type:Individual
Prefix:
First Name:OSITA
Middle Name:E
Last Name:OKPALAOKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BANBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2095
Mailing Address - Country:US
Mailing Address - Phone:614-920-2181
Mailing Address - Fax:614-920-2182
Practice Address - Street 1:5801 TAMARACK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3747
Practice Address - Country:US
Practice Address - Phone:614-436-6009
Practice Address - Fax:614-436-6011
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0654-0207P00000X
OH35-08-0654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292951Medicaid
OH5619197341C1ROtherBLUECROSS BLUESHIELD
OH5619197341C1ROtherBLUECROSS BLUESHIELD
OH2292951Medicaid
OH4094533Medicare PIN
OH4094539Medicare PIN
OH4094533Medicare PIN