Healthcare Provider Details

I. General information

NPI: 1568372340
Provider Name (Legal Business Name): ESTHER ODUNOLA BALOGUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8237 EBAUGH DR
CAMBY IN
46113-9506
US

IV. Provider business mailing address

8237 EBAUGH DR
CAMBY IN
46113-9506
US

V. Phone/Fax

Practice location:
  • Phone: 317-495-0557
  • Fax:
Mailing address:
  • Phone: 317-495-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30011895A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: