Healthcare Provider Details

I. General information

NPI: 1629241443
Provider Name (Legal Business Name): JOSEPHINE N EMOLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE NGOZI EZE MD

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE STE 105
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-5500
  • Fax: 317-528-6316
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301111667
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01100231A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number01100231A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301111667
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01100231A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: