Provider Demographics
NPI:1902851330
Name:OKOLOCHA MEDICAL CORP.
Entity Type:Organization
Organization Name:OKOLOCHA MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHIKE
Authorized Official - Last Name:OKOLOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-949-7540
Mailing Address - Street 1:1314 FITZGERALD DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4204
Mailing Address - Country:US
Mailing Address - Phone:219-922-4802
Mailing Address - Fax:
Practice Address - Street 1:2054 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3060
Practice Address - Country:US
Practice Address - Phone:219-949-7540
Practice Address - Fax:219-949-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000285585OtherBC/BS
IN000000285585OtherBC/BS
IN185850Medicare ID - Type Unspecified