Healthcare Provider Details

I. General information

NPI: 1538168620
Provider Name (Legal Business Name): UZOMA OKOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S GREENLEAF ST SUITE J
GURNEE IL
60031-3398
US

IV. Provider business mailing address

PO BOX 6119
VERNON HILLS IL
60061-6119
US

V. Phone/Fax

Practice location:
  • Phone: 847-672-6478
  • Fax: 847-672-7432
Mailing address:
  • Phone: 847-672-6478
  • Fax: 847-672-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number036109992
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-109992
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: