MEDICARE: ENOLA OKONKWO

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	207P00000X	Emergency Medicine Physician	209545	NC
2	207P00000X	Emergency Medicine Physician	ME136421	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AMA8	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861888430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOLA OKONKWO

Provider Business Mailing Address
First Line	:	9785 VALLEY SPRINGS BLVD
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-8764
Country	:	US
Telephone Number	:	317-460-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	9785 VALLEY SPRINGS BLVD
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-8764
Country	:	US
Telephone Number	:	317-460-6691
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	03/14/2023

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Directions to “ ENOLA OKONKWO ” Practice Location

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