Provider Demographics
NPI:1447343017
Name:OKORONKWO, CATHERINE N (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:N
Last Name:OKORONKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W. IRVING BLVD
Mailing Address - Street 2:STE 151
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061
Mailing Address - Country:US
Mailing Address - Phone:972-254-7272
Mailing Address - Fax:972-254-7575
Practice Address - Street 1:1711 W. IRVING BLVD
Practice Address - Street 2:STE 151
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061
Practice Address - Country:US
Practice Address - Phone:972-254-7272
Practice Address - Fax:972-254-7575
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127465604Medicaid
TX0080MSOtherBLUECROSS BLUESHIELD
TX0080MSOtherBLUECROSS BLUESHIELD
TX8A3030Medicare PIN