Healthcare Provider Details

I. General information

NPI: 1205869419
Provider Name (Legal Business Name): ATINUKE R UWAJEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ATINUKE EGBESEMI-RONE

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9831 S WESTERN AVE
CHICAGO IL
60643-1791
US

IV. Provider business mailing address

701 LEE ST SUITE 300
DES PLAINES IL
60016-4539
US

V. Phone/Fax

Practice location:
  • Phone: 773-445-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-092841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: