Healthcare Provider Details

I. General information

NPI: 1942247457
Provider Name (Legal Business Name): OZURU OCHU UKOHA M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1642 TINA LN
FLOSSMOOR IL
60422-1907
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-5265
  • Fax: 312-864-9649
Mailing address:
  • Phone: 708-799-8224
  • Fax: 708-799-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036-103422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: