Individual
TAVONNA DENISE KAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01093997A
IN
207VX0000X
Obstetrics Physician
Primary
01093997A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104256339
ANTHEM PTAN
IN
05
—
300093177
—
IN
Enumeration date
08/29/2019
Last updated
11/06/2025
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