Healthcare Provider Details

I. General information

NPI: 1114964673
Provider Name (Legal Business Name): UDOCHUKWU O ASONYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

900 JORIE BLVD SUITE 186
OAK BROOK IL
60523-2213
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2226
  • Fax:
Mailing address:
  • Phone: 630-954-6700
  • Fax: 630-954-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036052108
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036052108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: