Healthcare Provider Details

I. General information

NPI: 1417872433
Provider Name (Legal Business Name): HASSAN UDEOGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 W SALT CREEK LN
ARLINGTON HEIGHTS IL
60005-1008
US

IV. Provider business mailing address

3060 W SALT CREEK LN
ARLINGTON HEIGHTS IL
60005-1008
US

V. Phone/Fax

Practice location:
  • Phone: 224-256-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: