Provider Demographics
NPI:1043375934
Name:CHIKARE HEALTH SERVICES INC
Entity type:Organization
Organization Name:CHIKARE HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:KANAYO
Authorized Official - Middle Name:K
Authorized Official - Last Name:ODELUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-397-6000
Mailing Address - Street 1:915 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3308
Mailing Address - Country:US
Mailing Address - Phone:219-397-6000
Mailing Address - Fax:219-397-6358
Practice Address - Street 1:915 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-397-6000
Practice Address - Fax:219-397-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D0956269OtherCLIA
CG2552OtherPALMETO GBA MEDICA
IN200210560AMedicaid