Provider Demographics
NPI:1356310718
Name:OKOYE, MATTHIAS I (MD)
Entity type:Individual
Prefix:
First Name:MATTHIAS
Middle Name:I
Last Name:OKOYE
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 30141
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-1241
Mailing Address - Country:US
Mailing Address - Phone:308-647-4900
Mailing Address - Fax:308-647-5378
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-486-3447
Practice Address - Fax:402-486-3477
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13904207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79717Medicare UPIN
NE276467Medicare ID - Type Unspecified