Healthcare Provider Details

I. General information

NPI: 1881793552
Provider Name (Legal Business Name): JAMES BOB ACHEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 S HALSTED ST
CHICAGO IL
60628-3126
US

IV. Provider business mailing address

10810 S HALSTED ST
CHICAGO IL
60628-3126
US

V. Phone/Fax

Practice location:
  • Phone: 773-785-9000
  • Fax: 773-785-9191
Mailing address:
  • Phone: 773-785-9000
  • Fax: 773-785-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036-054592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: