Provider Demographics
NPI:1407635253
Name:INDIANA MEDICAL TRANSPORTATION PROFESSION, LLC
Entity Type:Organization
Organization Name:INDIANA MEDICAL TRANSPORTATION PROFESSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ONWUKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:219-545-9315
Mailing Address - Street 1:650 S LAKE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 S LAKE ST STE B
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2928
Practice Address - Country:US
Practice Address - Phone:219-545-9315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)