MEDICARE: REGINALD NNAMDI OKAGBUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036095405	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235309352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD NNAMDI OKAGBUE MD

Provider Business Mailing Address
First Line	:	5736 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4152
Country	:	US
Telephone Number	:	773-385-9850
Fax Number	:	773-385-9850

Provider Business Practice Location Address
First Line	:	5736 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4152
Country	:	US
Telephone Number	:	773-385-9850
Fax Number	:	773-385-9850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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