Provider Demographics
NPI:1396936365
Name:DIANA M OKON, M.D. PC
Entity type:Organization
Organization Name:DIANA M OKON, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-284-2712
Mailing Address - Street 1:1319 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3759
Mailing Address - Country:US
Mailing Address - Phone:812-284-2712
Mailing Address - Fax:812-284-2747
Practice Address - Street 1:1319 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3759
Practice Address - Country:US
Practice Address - Phone:812-284-2712
Practice Address - Fax:812-284-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032826207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN195110Medicare PIN
INE29046Medicare UPIN