Healthcare Provider Details

I. General information

NPI: 1134308372
Provider Name (Legal Business Name): DAVID RYUSUKE OKANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 WEST MICHIGAN STREET FESLER HALL RM 204
INDIANAPOLIS IN
46202-5135
US

IV. Provider business mailing address

1120 SOUTH DR FESLER HALL, RM. 204
INDIANAPOLIS IN
46202-5135
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0275
  • Fax: 317-274-0256
Mailing address:
  • Phone: 317-274-0269
  • Fax: 317-274-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01063992A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: