Provider Demographics
NPI:1568691699
Name:OKOLO, PHYLLIS I (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:I
Last Name:OKOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 TURNING BASIN DR STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-4059
Mailing Address - Country:US
Mailing Address - Phone:832-344-3715
Mailing Address - Fax:
Practice Address - Street 1:1717 TURNING BASIN DR STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-4059
Practice Address - Country:US
Practice Address - Phone:832-344-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072717A207R00000X
TXT1798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine