Healthcare Provider Details

I. General information

NPI: 1477741304
Provider Name (Legal Business Name): OKWUJE MEDICAL SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4200
US

IV. Provider business mailing address

PO BOX 26975
JACKSONVILLE FL
32226-6975
US

V. Phone/Fax

Practice location:
  • Phone: 773-550-5187
  • Fax:
Mailing address:
  • Phone: 904-503-1132
  • Fax: 888-886-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036053172
License Number StateIL

VIII. Authorized Official

Name: MR. ORVILLE C ROSE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-503-1132