Healthcare Provider Details

I. General information

NPI: 1992938716
Provider Name (Legal Business Name): HEITOR OKANOBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HEITOR OKANOBO M.D.

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

IV. Provider business mailing address

2330 UTAH AVE
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 317-579-2150
  • Fax: 317-579-2130
Mailing address:
  • Phone: 424-290-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME119655
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01097980A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: