Healthcare Provider Details

I. General information

NPI: 1346281110
Provider Name (Legal Business Name): CLARA AKHIGBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 S STEWART AVE STE 313
CHICAGO IL
60621-3116
US

IV. Provider business mailing address

71 REGENT DRIVE
OAK BROOK IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-0633
  • Fax: 773-994-2174
Mailing address:
  • Phone: 773-962-0633
  • Fax: 773-994-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036085642
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036085642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: