15D2173407 CLIA NUMBER - OKOLOCHA MEDICAL CORP

Laboratory Demographics

CLIA Number: 15D2173407

Facility Name: OKOLOCHA MEDICAL CORP

Facility Address:
2054 GRANT ST
GARY, IN
ZIP 46404
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Facility Phone Number: 219 949-7540

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902851330

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	15D2173407
LAB Type	Physician Office
Facility Name	OKOLOCHA MEDICAL CORP
Street	2054 GRANT ST
City	GARY
State	IN
ZIP	46404
Phone	219 949-7540
CertificateType	4
CertificateEffectiveDate	10/11/2023
CertificateExpirationDate	10/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024