KANAYO K ODELUGA MD MPH NPI 1023173895

NPI Information

NPI: 1023173895
Provider Name: KANAYO K ODELUGA, MD, MPH
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
915 W CHICAGO AVE
EAST CHICAGO, IN
ZIP 46312
Phone: (219) 397-6000
Get Directions

Kanayo K Odeluga, MD, MPH is a general practice in East Chicago, IN with 39 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Kanayo K Odeluga, MD, MPH NPI is 1023173895. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

915 W CHICAGO AVE
EAST CHICAGO, IN
ZIP 46312
Phone: (219) 397-6000
Fax: (219) 397-6358

The NPI 1023173895 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/22/2006 and was last updated on 3/21/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		01047947	INDIANA	No
2	207R00000X	Internal Medicine		036092504	ILLINOIS	No
3	2083P0500X	Preventive Medicine	Preventive Medicine/Occupational Environmental Medicine	01047947	INDIANA	No
4	2083P0500X	Preventive Medicine	Preventive Medicine/Occupational Environmental Medicine	036092504	ILLINOIS	No
5	208D00000X	General Practice		036092504	ILLINOIS	No
6	208D00000X	General Practice		01047947	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000D93250	OTHER		ANTHEM BCBS
2	200195020	MEDICAID	INDIANA
3	080148350	OTHER		PALMETTO GBA MEDI
4	G43801	MEDICARE UPIN
5	133460B	MEDICARE PIN	INDIANA
6	01047947	OTHER	INDIANA	LICENSING BOARD
7	036092504	OTHER	ILLINOIS	IL DEPT OF HEALTHCARE & F
8	10593989	OTHER		CAQH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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