=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184578858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OTANGELES MEDICAL OF INDIANA, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2026
-----------------------------------------------------
Last Update Date | 02/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7951 CALUMET AVE
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-256-6002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 DERBY WAY
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-256-6002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DIONNE C OKAFOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 219-256-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------