MEDICARE: DR. NGOZI OGBUNAMIRI EZIKE 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	36-108225	IL
2	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1447389994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGOZI OGBUNAMIRI EZIKE MD

Provider Business Mailing Address
First Line	:	PO BOX 292
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-0292
Country	:	US
Telephone Number	:	708-288-8222
Fax Number	:	708-579-9573

Provider Business Practice Location Address
First Line	:	4800 W CHICAGO AVE
Second Line	:	1ST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60651-3223
Country	:	US
Telephone Number	:	773-826-9600
Fax Number	:	773-826-9601

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	09/11/2025

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