Healthcare Provider Details

I. General information

NPI: 1962686485
Provider Name (Legal Business Name): EMMANUEL OBUMNEME NWADIKE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OBUMNEME EMMANUEL NWADIKE M.D

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125050586
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52855
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number52855
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: