Provider Demographics
NPI:1457560492
Name:OKOLI, OBIEFUNA CHIDOZIE (MD)
Entity Type:Individual
Prefix:DR
First Name:OBIEFUNA
Middle Name:CHIDOZIE
Last Name:OKOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2801 MISSOURI AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5075
Mailing Address - Country:US
Mailing Address - Phone:575-522-6900
Mailing Address - Fax:575-522-8891
Practice Address - Street 1:2801 MISSOURI AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5075
Practice Address - Country:US
Practice Address - Phone:575-522-6900
Practice Address - Fax:575-522-8891
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0176207RI0200X
FLME106648207RI0200X
WI51559-020207RI0200X
IL125049913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine