Healthcare Provider Details

I. General information

NPI: 1912981374
Provider Name (Legal Business Name): KAMANA ESTHER MBEKEANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST DIVISION OF SURGICAL CRITICAL CARE
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1230 N KENILWORTH AVE
OAK PARK IL
60302-1237
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-5268
  • Fax:
Mailing address:
  • Phone: 708-383-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: