Healthcare Provider Details

I. General information

NPI: 1811920036
Provider Name (Legal Business Name): EMEKA EZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E. 95TH STREET JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC
CHICAGO IL
60617
US

IV. Provider business mailing address

2231 E. 95TH STREET JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC
CHICAGO IL
60617
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-7700
  • Fax: 773-768-7768
Mailing address:
  • Phone: 773-768-7700
  • Fax: 773-768-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-114419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: