Provider Demographics
NPI:1134308372
Name:OKANO, DAVID RYUSUKE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RYUSUKE
Last Name:OKANO
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 1:1120 SOUTH DR
Mailing Address - Street 2:FESLER HALL, RM. 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5135
Mailing Address - Country:US
Mailing Address - Phone:317-274-0269
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:1130 WEST MICHIGAN STREET
Practice Address - Street 2:FESLER HALL RM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5135
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063992A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000576095OtherANTHEM-PAIN
IN200905390Medicaid
IN000000567891OtherANTHEM-ANESTHESIA
IN200905390Medicaid
IN095200MMMMMedicare PIN