Healthcare Provider Details

I. General information

NPI: 1023451481
Provider Name (Legal Business Name): FLAVIEN ITUKA MOKEYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 INTELLIPLEX DR STE 200
SHELBYVILLE IN
46176-8549
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-2812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01093226A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: