Provider Demographics
NPI:1427073980
Name:OKORO, CHARLES CHUKWAMA (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHUKWAMA
Last Name:OKORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 IDLEWOOD PKWY
Mailing Address - Street 2:APT 502
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1988
Mailing Address - Country:US
Mailing Address - Phone:317-328-8366
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2501
Practice Address - Fax:317-988-3243
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058999A207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200846210Medicaid
IN000000613056OtherANTHEM BCBS
IN131180RRRMedicare PIN