Provider Demographics
NPI:1235578055
Name:CRAIN, AOKO DORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:AOKO
Middle Name:DORIS
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AOKO
Other - Middle Name:DORIS
Other - Last Name:KAWIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1033
Mailing Address - Country:US
Mailing Address - Phone:574-647-7167
Mailing Address - Fax:574-647-3671
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-7459
Practice Address - Fax:574-647-3658
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-063112207P00000X
IN01076165A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001024836OtherANTHEM
IN201367630Medicaid
IN941030007Medicare PIN