Individual
KANAYO K ODELUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
915 W CHICAGO AVE, EAST CHICAGO, IN 46312
(219) 397-6000
(219) 397-6358
Mailing address
915 W CHICAGO AVE, EAST CHICAGO, IN 46312-3308
(219) 397-6000
(219) 397-6358
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
01047947
IN
208D00000X
General Practice Physician
036092504
IL
Other
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
Enumeration date
12/22/2006
Last updated
03/21/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us