Healthcare Provider Details

I. General information

NPI: 1164859880
Provider Name (Legal Business Name): JOINT HEIRS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E LINCOLN RD
KOKOMO IN
46902-3716
US

IV. Provider business mailing address

419 E LINCOLN RD
KOKOMO IN
46902-3716
US

V. Phone/Fax

Practice location:
  • Phone: 765-864-2400
  • Fax: 765-864-2401
Mailing address:
  • Phone: 765-864-2400
  • Fax: 765-864-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01062399
License Number StateIN

VIII. Authorized Official

Name: DR. ABIMBOLA ODUKOYA
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 646-675-1263