Healthcare Provider Details

I. General information

NPI: 1366141459
Provider Name (Legal Business Name): OBASEKI & ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4552 N BROADWAY ST UNIT 214
CHICAGO IL
60640-5602
US

IV. Provider business mailing address

4552 N BROADWAY ST UNIT 214
CHICAGO IL
60640-5602
US

V. Phone/Fax

Practice location:
  • Phone: 773-791-3116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: NOSADEBA OBASEKI
Title or Position: SECRETARY
Credential:
Phone: 773-791-3116