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

Table of content: (NPI 1821287871)

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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