Healthcare Provider Details

I. General information

NPI: 1891585899
Provider Name (Legal Business Name): MURTALA AFFINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1865
  • Fax: 773-834-3888
Mailing address:
  • Phone: 773-702-1865
  • Fax: 773-834-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125086762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: