1003994955 NPI number — ROPHEKA MEDICAL SERVICE LTD

Table of content: (NPI 1003994955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003994955 NPI number — ROPHEKA MEDICAL SERVICE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROPHEKA MEDICAL SERVICE LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003994955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 745
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60130-0745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-214-5300
Provider Business Mailing Address Fax Number:
773-913-2314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 W 103RD ST
Provider Second Line Business Practice Location Address:
1ST FLOOR EAST WING
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-779-9890
Provider Business Practice Location Address Fax Number:
773-779-9830
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLATUNBOSUN
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
TAIWO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-214-5300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)