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Individual

CHINYERE I ODELUGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
915 WEST CHICAGO AVENUE, 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
163W00000X
Registered Nurse
041278213
IL
207Q00000X
Family Medicine Physician
Primary
01045992
IN
207Q00000X
Family Medicine Physician
036092321
IL
208D00000X
General Practice Physician
01045992
IN
208D00000X
General Practice Physician
036092321
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000093249
ANTHEM BC BS
01
01045992
LICENSE BOARD
IN
01
036092321
LICENSE BOARD
IL
01
080148349
PALMETO GBA MEDICAL
01
10784830
LAQH
05
200118940
IN
Enumeration date
12/22/2006
Last updated
03/21/2013
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