Healthcare Provider Details

I. General information

NPI: 1639272727
Provider Name (Legal Business Name): ARLENE OBAZEE PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 S MICHIGAN AVE
CHICAGO IL
60637-1012
US

IV. Provider business mailing address

4621 FARMINGTON AVE
RICHTON PARK IL
60471-1807
US

V. Phone/Fax

Practice location:
  • Phone: 773-643-0400
  • Fax: 773-643-0640
Mailing address:
  • Phone: 708-503-0455
  • Fax: 773-643-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1059376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: