Individual
DR. ENANORE E OKUMAGBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5751 UNIVERSITY AVE, #108 BOX 410, INDIANAPOLIS, IN 46219-7222
(317) 927-1761
(407) 767-0750
Mailing address
950 N. MERIDIAN STREET, PROVIDER ENROLLMENT SUITE 500, INDIANAPOLIS, IN 46204-3908
(317) 962-4944
(317) 962-4950
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01069813
IN
207R00000X
Internal Medicine Physician
2009-01946
NC
208M00000X
Hospitalist Physician
2009-01946
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000723422
ANTHEM PIN
IN
01
—
148P3
BLUE CROSS OF FL
FL
05
—
201026800
—
IN
Enumeration date
11/07/2009
Last updated
12/06/2011
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