Provider Demographics
NPI:1639864911
Name:OKOYE, VIVIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:OKOYE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W 68TH ST # 3-SOUTH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1813
Mailing Address - Country:US
Mailing Address - Phone:773-434-4040
Mailing Address - Fax:773-434-4135
Practice Address - Street 1:2701 W 68TH ST # 3-SOUTH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:773-434-4040
Practice Address - Fax:773-434-4135
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL085009865207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program