1821287871 NPI number — UCHE OLEKANMA M.D S.C

Table of content: MADHURA SUBHASH BORIKAR MD (NPI 1467838441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821287871 NPI number — UCHE OLEKANMA M.D S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCHE OLEKANMA M.D S.C
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:
1821287871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 S ASHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60620-4626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-873-3434
Provider Business Mailing Address Fax Number:
773-873-0208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 S ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60620-4626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-873-3434
Provider Business Practice Location Address Fax Number:
773-873-0208
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLEKANMA
Authorized Official First Name:
UCHENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-863-5162

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036114328 , 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: 11581877 . This is a "CAQH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1821287871 . This is a "NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5566-0185 . This is a "ILLINOIS IBT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 20014750 . This is a "IL PCP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036114328 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22001745P03 . This is a "PLICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036114328 . This is a "PROFESSIONAL LICENCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 14D1075800 . This is a "CLIA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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