Healthcare Provider Details

I. General information

NPI: 1558855387
Provider Name (Legal Business Name): SAJEL ELIZABETH NUWAMANYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

IV. Provider business mailing address

879 N RICHMOND ST
CHICAGO IL
60622-4311
US

V. Phone/Fax

Practice location:
  • Phone: 872-588-3000
  • Fax: 872-588-3001
Mailing address:
  • Phone: 248-326-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberL.4749
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301504083
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.170528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: