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Individual

TAVONNA DENISE KAKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6002 E 38TH ST, INDIANAPOLIS, IN 46226-5614
(317) 880-6002
(317) 880-0417
Mailing address
701 S GREENLEAF CT, BLOOMINGTON, IN 47403-5858

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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