Healthcare Provider Details

I. General information

NPI: 1609372218
Provider Name (Legal Business Name): EMENIKE ADOLPHUS OKAFOR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

1415 STADIUM WAY UNIT 4105
INDIANAPOLIS IN
46202-2154
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-9169
  • Fax:
Mailing address:
  • Phone: 615-429-4308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: