Healthcare Provider Details

I. General information

NPI: 1851915342
Provider Name (Legal Business Name): CHIKE FLOYD OKOLOCHA JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CALUMET AVE
VALPARAISO IN
46383-2715
US

IV. Provider business mailing address

2505 CALUMET AVE
VALPARAISO IN
46383-2715
US

V. Phone/Fax

Practice location:
  • Phone: 219-548-3843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT8905
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10071689
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02007168A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: