Healthcare Provider Details

I. General information

NPI: 1417902388
Provider Name (Legal Business Name): MAYUMI OKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 BROADWAY
MERRILLVILLE IN
46410-7035
US

IV. Provider business mailing address

55 E 86TH AVE PO BOX 10645
MERRILLVILLE IN
46410-6382
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-5565
  • Fax: 219-738-6714
Mailing address:
  • Phone: 219-769-1670
  • Fax: 219-738-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01060110
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: