Healthcare Provider Details

I. General information

NPI: 1992699425
Provider Name (Legal Business Name): EUNICE ONYINYE MEJULU MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE
CHICAGO IL
60608-1782
US

IV. Provider business mailing address

1500 S FAIRFIELD AVE DEPT OF
CHICAGO IL
60608-1782
US

V. Phone/Fax

Practice location:
  • Phone: 240-903-4606
  • Fax:
Mailing address:
  • Phone: 240-903-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.085843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: