Healthcare Provider Details

I. General information

NPI: 1508526674
Provider Name (Legal Business Name): NNEKA ODERA CHISOM NWEKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E ONTARIO ST STE 200
CHICAGO IL
60611-3284
US

IV. Provider business mailing address

211 E ONTARIO ST STE 200
CHICAGO IL
60611-3284
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-7000
  • Fax: 312-926-6274
Mailing address:
  • Phone: 312-694-7000
  • Fax: 312-926-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: