| Okolocha Medical Corp. | |
|
2054 Grant St Gary IN 46404-3060 | |
| (219) 949-7540 | |
| (219) 949-7545 |
| Full Name | Okolocha Medical Corp. |
|---|---|
| Speciality | Family Medicine |
| Location | 2054 Grant St, Gary, Indiana |
| Authorized Official Name and Position | Paul Chike Okolocha (PHYSICIAN) |
| Authorized Official Contact | 2199497540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Okolocha Medical Corp. 1314 Fitzgerald Dr Munster IN 46321-4204 Ph: (219) 922-4802 | Okolocha Medical Corp. 2054 Grant St Gary IN 46404-3060 Ph: (219) 949-7540 |
| NPI Number | 1902851330 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5597794834 |
|---|---|
| Medicare Enrollment ID | O20050808000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902851330 | NPI | - | NPPES |
| 000000285585 | Other | IN | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01041856 (Indiana) | Primary |
| Provider Name | Paul C Okolocha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629193321 PECOS PAC ID: 2860421104 Enrollment ID: I20100522000064 |
| Provider Name | Eunice Okolocha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578763447 PECOS PAC ID: 9032200761 Enrollment ID: I20111214000918 |
| Provider Name | Sandra Renee Gates Manna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124396072 PECOS PAC ID: 0749431203 Enrollment ID: I20121108000643 |
| Provider Name | Jeong Ho Ryu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730163189 PECOS PAC ID: 9436112679 Enrollment ID: I20150216001817 |
| Provider Name | Lillian D Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447663398 PECOS PAC ID: 2860610193 Enrollment ID: I20161228000400 |
| Provider Name | Hanifa Waarith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205426723 PECOS PAC ID: 4789099052 Enrollment ID: I20210218001629 |
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