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General NPI Number Information
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NPI Number | 1922053354
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Entity Type | Organization
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Legal Business Name | OKOLOCHA MEDICAL PAIN & WEIGHT CLINIC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3847 EUCLID AVE
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2332
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Country | US
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Telephone | 219-398-0700
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Fax | 219-398-4914
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Provider Business Mailing Address
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Address Line | 3048 LAKESIDE DR
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City | HIGHLAND
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State | IN
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Zip | 46322-3470
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Country | US
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Telephone | 219-922-1581
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AMBROSIO ARANAS DOSADO
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Credential | M.D.
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Telephone | 219-398-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01044052
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License Number State | IN
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