Healthcare Provider Details

I. General information

NPI: 1083590830
Provider Name (Legal Business Name): CHISOM OGBOZOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W WARREN BLVD UNIT G
CHICAGO IL
60612-2258
US

IV. Provider business mailing address

2226 W WARREN BLVD UNIT G
CHICAGO IL
60612-2258
US

V. Phone/Fax

Practice location:
  • Phone: 815-302-4581
  • Fax:
Mailing address:
  • Phone: 815-302-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070028497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: