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General NPI Number Information
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NPI Number | 1518398882
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Entity Type | Organization
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Legal Business Name | NORTHWEST INDIANA OCCUPATIONAL PAIN AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 399 E 84TH DR
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6484
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Country | US
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Telephone | 219-949-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 55 E 86TH AVE ATTN DENISE Z
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6382
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Country | US
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Telephone | 219-769-1670
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Fax | 219-738-6714
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Authorized Official
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Title or Position | OWNER
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Name | PAUL OKOLOCHA
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Credential | MD
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Telephone | 219-949-7540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State | IN
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