Provider Demographics
NPI:1629026455
Name:OKINEDO, CLEMENT U (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:U
Last Name:OKINEDO
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-341-2909
Mailing Address - Fax:256-973-2552
Practice Address - Street 1:408 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5124
Practice Address - Country:US
Practice Address - Phone:256-489-0489
Practice Address - Fax:256-489-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557491Medicare ID - Type Unspecified
ALH36522Medicare UPIN