Healthcare Provider Details

I. General information

NPI: 1538354295
Provider Name (Legal Business Name): OTUONYE E ONYEWUCHI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E 87TH ST STE 109
CHICAGO IL
60617-2706
US

IV. Provider business mailing address

1750 E 87TH ST STE 109
CHICAGO IL
60617-2706
US

V. Phone/Fax

Practice location:
  • Phone: 773-933-9300
  • Fax: 773-933-9302
Mailing address:
  • Phone: 773-933-9300
  • Fax: 773-933-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36118945
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-118945
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036118945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: