Healthcare Provider Details

I. General information

NPI: 1710516976
Provider Name (Legal Business Name): OLHA HUZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-8200
  • Fax:
Mailing address:
  • Phone: 773-292-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036161910
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01090939A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01090939A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036161910
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036161910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: