Healthcare Provider Details

I. General information

NPI: 1770212813
Provider Name (Legal Business Name): NKIRUKA PERPETUA OSEFO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

V. Phone/Fax

Practice location:
  • Phone: 773-378-3347
  • Fax: 773-378-4028
Mailing address:
  • Phone: 773-378-3347
  • Fax: 773-378-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: