Healthcare Provider Details

I. General information

NPI: 1962452193
Provider Name (Legal Business Name): RITA N OGANWU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203030 S. CRAWFORD AVE STE 110
OLYMPIA FIELDS IL
60461
US

IV. Provider business mailing address

203030 S. CRAWFORD AVE STE 110
OLYMPIA FIELDS IL
60461
US

V. Phone/Fax

Practice location:
  • Phone: 708-922-9170
  • Fax: 708-922-9180
Mailing address:
  • Phone: 708-922-9170
  • Fax: 708-922-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036074918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: