Provider Demographics
NPI:1235390303
Name:JEPKORIR, CAROLYNE JEPCHIRCHIR (MD)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYNE
Middle Name:JEPCHIRCHIR
Last Name:JEPKORIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROLYNE
Other - Middle Name:JEPCHIRCHIR
Other - Last Name:JEPKORIR-KITONYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:5510 S EAST ST STE H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1939
Practice Address - Country:US
Practice Address - Phone:317-924-8425
Practice Address - Fax:317-924-8424
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068942207RN0300X
IN01068942A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201157080Medicaid
IN076330002Medicare PIN