Provider Demographics
NPI:1740264571
Name:OKEREKE, OKEZIKA J (MD PA)
Entity type:Individual
Prefix:DR
First Name:OKEZIKA
Middle Name:J
Last Name:OKEREKE
Suffix:
Gender:M
Credentials:MD PA
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 4680
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4680
Mailing Address - Country:US
Mailing Address - Phone:956-399-2920
Mailing Address - Fax:956-399-2940
Practice Address - Street 1:1000 N DICK DOWLING ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5222
Practice Address - Country:US
Practice Address - Phone:956-399-2920
Practice Address - Fax:956-399-2940
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1599174400000X, 207P00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113307602Medicaid
TX0022DKOtherBLUE CROSS/BLUE SHIELD
TX00134JMedicare ID - Type Unspecified
TX0022DKOtherBLUE CROSS/BLUE SHIELD