Healthcare Provider Details

I. General information

NPI: 1003163932
Provider Name (Legal Business Name): AUGUSTINE NNADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NORTH LAKE SHORE DRIVE SAINT JOSEPH HOSPITAL INTERNAL MEDICINE DEPT
CHICAGO IL
60657
US

IV. Provider business mailing address

2900 NORTH LAKE SHORE DRIVE SAINT JOSEPH HOSPITAL INTERNAL MEDICINE DEPT
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125062028
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01075415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: