MEDICARE: ULTRA INVESTMENT CORP.

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	347B00000X	Bus	6062601	IL

General Provider Information

NPI Number	:	1770757387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA INVESTMENT CORP.

Provider Business Mailing Address
First Line	:	1607 W HOWARD ST
Second Line	:	4TH FLOOR SUITE A1
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	773-508-5466
Fax Number	:	773-465-0406

Provider Business Practice Location Address
First Line	:	1607 W HOWARD ST
Second Line	:	4TH FLOOR SUITE A1
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	773-508-5466
Fax Number	:	773-465-0406

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ADEBAYO A AFOLABI
Credential	:
Telephone Number	:	773-508-5466

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	07/21/2022

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Directions to “ULTRA INVESTMENT CORP. ” Practice Location

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