Provider Demographics
NPI:1316107444
Name:OKOSUN, STANLEY E (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:E
Last Name:OKOSUN
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 67250
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7250
Mailing Address - Country:US
Mailing Address - Phone:402-328-8833
Mailing Address - Fax:402-328-2921
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3704
Practice Address - Country:US
Practice Address - Phone:402-328-8833
Practice Address - Fax:402-328-2921
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25144208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200634870AMedicaid
NEP00739812OtherRAILROAD MEDICARE
IAN/AMedicaid
NE47077696002Medicaid
NE10025037900Medicaid
NE13914OtherBCBS
IAN/AMedicaid
KS200634870AMedicaid