Healthcare Provider Details

I. General information

NPI: 1447389994
Provider Name (Legal Business Name): NGOZI OGBUNAMIRI EZIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 W CHICAGO AVE 1ST FLOOR
CHICAGO IL
60651-3223
US

IV. Provider business mailing address

PO BOX 292
LA GRANGE IL
60525-0292
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-9600
  • Fax: 773-826-9601
Mailing address:
  • Phone: 708-288-8222
  • Fax: 708-579-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36-108225
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: