Healthcare Provider Details

I. General information

NPI: 1922053354
Provider Name (Legal Business Name): OKOLOCHA MEDICAL PAIN & WEIGHT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 EUCLID AVE
EAST CHICAGO IN
46312-2332
US

IV. Provider business mailing address

3048 LAKESIDE DR
HIGHLAND IN
46322-3470
US

V. Phone/Fax

Practice location:
  • Phone: 219-398-0700
  • Fax: 219-398-4914
Mailing address:
  • Phone: 219-922-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01044052
License Number StateIN

VIII. Authorized Official

Name: DR. AMBROSIO ARANAS DOSADO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 219-398-0700