Healthcare Provider Details

I. General information

NPI: 1164598504
Provider Name (Legal Business Name): AKRAM KHOLOKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SAINT MARY RD STE 202
VALPARAISO IN
46383-3986
US

IV. Provider business mailing address

3800 SAINT MARY RD STE 202
VALPARAISO IN
46383-3986
US

V. Phone/Fax

Practice location:
  • Phone: 219-286-3788
  • Fax: 219-286-3791
Mailing address:
  • Phone: 219-286-3788
  • Fax: 219-286-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01046098A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: