Healthcare Provider Details

I. General information

NPI: 1114106978
Provider Name (Legal Business Name): OSAFO HEALTH CARE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 REMINGTON BLVD STE G2
BOLINGBROOK IL
60440-3663
US

IV. Provider business mailing address

215 REMINGTON BLVD STE G2
BOLINGBROOK IL
60440-3663
US

V. Phone/Fax

Practice location:
  • Phone: 630-226-0162
  • Fax: 630-226-0160
Mailing address:
  • Phone: 630-226-0162
  • Fax: 630-226-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number036099549
License Number StateIL

VIII. Authorized Official

Name: SETH K OSAFO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-690-3369