Provider Demographics
NPI:1073774485
Name:NWAKA, AUSTIN (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:NWAKA
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3113
Mailing Address - Country:US
Mailing Address - Phone:317-541-1836
Mailing Address - Fax:317-541-1858
Practice Address - Street 1:3919 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3113
Practice Address - Country:US
Practice Address - Phone:317-541-1836
Practice Address - Fax:317-541-1858
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171M00000X
IN432084194207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200383070AMedicaid