Healthcare Provider Details

I. General information

NPI: 1306772991
Provider Name (Legal Business Name): ELISHA IDEMUDIA IKHUMHEN PT, DPT, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IDE IKHUMHEN PT, DPT, MPH

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N GREENVIEW AVE
CHICAGO IL
60657-3171
US

IV. Provider business mailing address

3101 N GREENVIEW AVE
CHICAGO IL
60657-3171
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-1898
  • Fax: 773-395-1434
Mailing address:
  • Phone: 773-270-1898
  • Fax: 773-395-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: