Provider Demographics
NPI:1154708022
Name:OKONKWO, NZUBE C (MD)
Entity type:Individual
Prefix:
First Name:NZUBE
Middle Name:C
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17070 RED OAK DR STE 403
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2609
Mailing Address - Country:US
Mailing Address - Phone:281-836-5691
Mailing Address - Fax:281-836-5692
Practice Address - Street 1:17070 RED OAK DR STE 403
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2609
Practice Address - Country:US
Practice Address - Phone:281-836-5691
Practice Address - Fax:281-836-5692
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK35061207QA0505X
TXT4811207QG0300X
MN62790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1154708022Medicaid