=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427073980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES CHUKWAMA OKORO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 04/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1481 W 10TH ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46202-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-988-2501
-----------------------------------------------------
Fax | 317-988-3243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3504 IDLEWOOD PKWY APT 502
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46214-1988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-328-8366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01058999A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 01058999A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------