# KANAYO K ODELUGA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023173895
- **Gender:** Man
- **Credential:** MD, MPH

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 01047947 | IN | — |
| 207R00000X | Internal Medicine Physician | 036092504 | IL | — |
| 2083P0500X | Preventive Medicine/Occupational Environmental Medicine Physician | 01047947 | IN | — |
| 2083P0500X | Preventive Medicine/Occupational Environmental Medicine Physician | 036092504 | IL | — |
| 208D00000X | General Practice Physician | 01047947 | IN | Yes |
| 208D00000X | General Practice Physician | 036092504 | IL | — |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 03/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000D93250 | ANTHEM BCBS | — |
| 01 | — | 01047947 | LICENSING BOARD | IN |
| 01 | — | 036092504 | IL DEPT OF HEALTHCARE & F | IL |
| 01 | — | 080148350 | PALMETTO GBA MEDI | — |
| 01 | — | 10593989 | CAQH | — |
| 05 | — | 200195020 | — | IN |