Provider Demographics
NPI:1588815914
Name:ODIGIE-OKON, ESOSA GLADYS (MD)
Entity Type:Individual
Prefix:
First Name:ESOSA
Middle Name:GLADYS
Last Name:ODIGIE-OKON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESOSA
Other - Middle Name:G
Other - Last Name:ODIGIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6920 POINTE INVERNESS WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6433
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281297207RC0000X
IN01078056A207RC0000X
WI63333207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease