Healthcare Provider Details

I. General information

NPI: 1235763863
Provider Name (Legal Business Name): ERNEST OGBEIDE APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date: 03/21/2025
Reactivation Date: 03/27/2025

III. Provider practice location address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-5000
  • Fax: 773-978-8367
Mailing address:
  • Phone: 773-768-5000
  • Fax: 773-978-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.020904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: