Healthcare Provider Details

I. General information

NPI: 1548234883
Provider Name (Legal Business Name): NYAMBI EBIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E 93RD ST SUITE 110
CHICAGO IL
60617-3913
US

IV. Provider business mailing address

505 N LAKE SHORE DR SUITE 5811
CHICAGO IL
60611-3427
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-2982
  • Fax: 773-731-3328
Mailing address:
  • Phone: 773-731-2982
  • Fax: 773-731-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036045826
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036045826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: