Healthcare Provider Details

I. General information

NPI: 1598512717
Provider Name (Legal Business Name): EUSTACIA CHIAMAKA IKERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-0715
US

IV. Provider business mailing address

3249 OAK PARK AVE
BERWYN IL
60402-0715
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3425
  • Fax:
Mailing address:
  • Phone: 708-783-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.087638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: