Healthcare Provider Details

I. General information

NPI: 1326355835
Provider Name (Legal Business Name): TOCHUKWU M OKWUOSA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 1010
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1600 DARIEN CLUB DR
DARIEN IL
60561-3684
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6253
  • Fax: 312-942-5829
Mailing address:
  • Phone: 312-942-6253
  • Fax: 312-942-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.115485
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101019067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: