Individual
TED GEORGE ODY ACHUFUSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1225 E COOLSPRING AVE STE 2F, MICHIGAN CITY, IN 46360-6312
(219) 873-2904
(219) 873-2483
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004055A
IN
207Q00000X
Family Medicine Physician
02004055B
IN
207Q00000X
Family Medicine Physician
036129835
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036129835
—
IL
01
—
151020027
PTAN
IN
05
—
201115610
—
KS
Enumeration date
04/26/2009
Last updated
12/16/2024
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