Provider Demographics
NPI:1689673683
Name:OKORO, LUWANGA UZOMA (DO)
Entity Type:Individual
Prefix:DR
First Name:LUWANGA
Middle Name:UZOMA
Last Name:OKORO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6258
Mailing Address - Country:US
Mailing Address - Phone:219-649-2750
Mailing Address - Fax:219-756-1410
Practice Address - Street 1:200 E 86TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6258
Practice Address - Country:US
Practice Address - Phone:219-649-2750
Practice Address - Fax:219-756-1410
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20007607207RC0000X
IN02003041A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200808940Medicaid
IN200808940Medicaid
IN192820UMedicare PIN
IN221020VMedicare PIN
IN192820UMedicare PIN