Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 01068679A | IN |
NPI | 1063659688 |
---|---|
Provider Name | Tochukwu C Iloabuchi |
First Address | Mccordsville, IN 46055-4447 |
Second Address | Mccordsville, IN 46055-4447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 22/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201069810 | (05) | IN |
P01114681 | RAILROAD MEDICARE (01) | IN |