Healthcare Provider Details

I. General information

NPI: 1639601123
Provider Name (Legal Business Name): OBADA OBAISI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST FL 4
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1520 W HARRISON ST FL 4
CHICAGO IL
60607-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-226-2371
  • Fax: 312-563-2371
Mailing address:
  • Phone: 312-226-2371
  • Fax: 312-563-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125071837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: