Healthcare Provider Details

I. General information

NPI: 1598949893
Provider Name (Legal Business Name): ANULI CHINAKA EZIMAKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

1611 S NORBURY AVE
LOMBARD IL
60148-6182
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-125242
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-125242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: