Provider Demographics
NPI:1124026646
Name:OAK, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:OAK
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 1:1400 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8005
Mailing Address - Country:US
Mailing Address - Phone:812-473-2642
Mailing Address - Fax:812-474-4458
Practice Address - Street 1:1400 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8005
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:812-474-4458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027388A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0080167091Medicaid
KY64164619Medicaid
KY0223324Medicare ID - Type Unspecified
ILL94227Medicare ID - Type Unspecified
KY64164619Medicaid
IN845900HHMedicare ID - Type Unspecified