MEDICARE: EJIOFOR CHIKA ACHALU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01096718A	IN
2	208D00000X	General Practice Physician	P110445	NY
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1105326166	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01096718A	OTHER	IN	PHYSICIAN LICENSE
4	P110445	OTHER	NY	PHYSICIAN LIMITED PERMIT

General Provider Information

NPI Number	:	1215509054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EJIOFOR CHIKA ACHALU MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5165 MCCARTY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-8764
Country	:	US
Telephone Number	:	765-448-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	01/08/2026

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