MEDICARE: CHARLES MOK JR. DO

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	207Q00000X	Family Medicine Physician	02002327A	IN

General Provider Information

NPI Number	:	1205828258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MOK JR. DO

Provider Business Mailing Address
First Line	:	1573 N CLINE AVE
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1567
Country	:	US
Telephone Number	:	219-838-2312
Fax Number	:	219-972-7177

Provider Business Practice Location Address
First Line	:	1573 N CLINE AVE
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1567
Country	:	US
Telephone Number	:	219-838-2312
Fax Number	:	219-972-7177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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Directions to “ CHARLES MOK JR. DO” Practice Location

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