Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 5101018246 | MI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5101018246 | MI |
NPI | 1053543090 |
---|---|
Provider Name | Dr. Collin James Okeefe |
First Address | Chicago, IL 60674-8434 |
Second Address | West Bloomfield, MI 48323-2184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2009 |
Last Update Date | 19/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0F33953 | BCBS (01) | MI |
13516741 | CAQH (01) | MI |