MEDICARE: DR. IFUNANYA OJUKWU 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	91695	GA
2	207Q00000X	Family Medicine Physician	MT217558	PA
3	207Q00000X	Family Medicine Physician	01090915A	IN

General Provider Information

NPI Number	:	1518525708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFUNANYA OJUKWU MD

Provider Business Mailing Address
First Line	:	5115 W WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-2205
Country	:	US
Telephone Number	:	317-799-1268
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 W WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-2205
Country	:	US
Telephone Number	:	317-799-1268
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	10/10/2023

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