MEDICARE: DR. CHRISTIAN ENYINNA OKEZIE M.D.

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	207Q00000X	Family Medicine Physician	036056093	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	:	1609939347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN ENYINNA OKEZIE M.D.

Provider Business Mailing Address
First Line	:	3124 KATHLEEN LN
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-1744
Country	:	US
Telephone Number	:	773-291-0035
Fax Number	:	773-291-0037

Provider Business Practice Location Address
First Line	:	972 E 133RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60827-1428
Country	:	US
Telephone Number	:	773-291-0035
Fax Number	:	773-291-0037

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

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	10/12/2012

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