Healthcare Provider Details

I. General information

NPI: 1093212888
Provider Name (Legal Business Name): NWI HOME DOCTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

3847 EUCLID AVE
EAST CHICAGO IN
46312-2332
US

V. Phone/Fax

Practice location:
  • Phone: 219-949-7540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL OKOLOCHA
Title or Position: PRESIDENT
Credential:
Phone: 219-949-7540