Provider Demographics
NPI:1265046221
Name:BIOKORO, DANIEL O
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:O
Last Name:BIOKORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 W 94TH CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2217
Mailing Address - Country:US
Mailing Address - Phone:219-779-1280
Mailing Address - Fax:
Practice Address - Street 1:1446 W 94TH CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2217
Practice Address - Country:US
Practice Address - Phone:219-779-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
67031420A183700000X
IN5360099694172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No183700000XPharmacy Service ProvidersPharmacy Technician