Provider Demographics
NPI:1700848116
Name:OKOJIE, OSEHOTUE (MD)
Entity Type:Individual
Prefix:
First Name:OSEHOTUE
Middle Name:
Last Name:OKOJIE
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 1:3825 ROSS AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5245
Mailing Address - Country:US
Mailing Address - Phone:214-515-9646
Mailing Address - Fax:214-515-9654
Practice Address - Street 1:3825 ROSS AVE
Practice Address - Street 2:STE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5245
Practice Address - Country:US
Practice Address - Phone:214-515-9646
Practice Address - Fax:214-515-9654
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203801001Medicaid
NYI23355Medicare UPIN