Provider Demographics
NPI:1871755884
Name:MACHOGU, EVANS MIRUKA (MD)
Entity type:Individual
Prefix:DR
First Name:EVANS
Middle Name:MIRUKA
Last Name:MACHOGU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROC 4270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-948-7208
Practice Address - Fax:317-944-5791
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN010731902080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201225810Medicaid
OH0143155Medicaid
IN201225810Medicaid