Provider Demographics
NPI:1578678868
Name:EKENNA, OKECHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:OKECHUKWU
Middle Name:
Last Name:EKENNA
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 1:4300 HOSPITAL ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5308
Mailing Address - Country:US
Mailing Address - Phone:228-769-2588
Mailing Address - Fax:228-769-2589
Practice Address - Street 1:4300 HOSPITAL ST STE 105
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5308
Practice Address - Country:US
Practice Address - Phone:228-769-2588
Practice Address - Fax:228-769-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS110101525OtherMEDICARE RAILROAD
MS009505210OtherALACAID
MS0114104Medicaid
MS106036700OtherUSDOL
MS110101525OtherMEDICARE RAILROAD
MS$$$$$$$$$BOtherBLUE CROSS
MS106036700OtherUSDOL
MS009505210OtherALACAID