MEDICARE: NWI HOME DOCTOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1093212888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWI HOME DOCTOR LLC

Provider Business Mailing Address
First Line	:	3847 EUCLID AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3847 EUCLID AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2332
Country	:	US
Telephone Number	:	219-949-7540
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL OKOLOCHA
Credential	:
Telephone Number	:	219-949-7540

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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Directions to “NWI HOME DOCTOR LLC ” Practice Location

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