1548234883 NPI number — MR. NYAMBI EBIE MD

Table of content: MR. NYAMBI EBIE MD (NPI 1548234883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548234883 NPI number — MR. NYAMBI EBIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBIE
Provider First Name:
NYAMBI
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1548234883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 N LAKE SHORE DR
Provider Second Line Business Mailing Address:
SUITE 5811
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-3427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-731-2982
Provider Business Mailing Address Fax Number:
773-731-3328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E 93RD ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-731-2982
Provider Business Practice Location Address Fax Number:
773-731-3328
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  036045826 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 036045826 , 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)

  • Identifier: 0001634652 . This is a "BCBS - IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036045826 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200165450A . This is a "PUBLIC AID - INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 210946 . This is a "ILLINOIS PTAN ( GROUP) CMGI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1548234883 . This is a "NPI - INDIVIDUAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 201129370A . This is a "INDIANA PROVIDER # ( GROUP ) CMGI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: K15828 . This is a "LEGACY NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00190421 . This is a "RAILROAD - IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00285036 . This is a "RAILROAD INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1376505065 . This is a "CMGI NPI (GROUP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000347617 . This is a "ANTHEM- BCBS- INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: IN1034 . This is a "INDIANA PTAN ( GROUP ) CMGI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 226920 . This is a "INDIANA PTAN - INDIVIDUAL- NYAMBI EBIE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com