Healthcare Provider Details

I. General information

NPI: 1952480196
Provider Name (Legal Business Name): CHINEDU C. ORANU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W. PARK ST. PEDIATRIC CRITICAL CARE
URBANA IL
61801-2500
US

IV. Provider business mailing address

611 W. PARK ST. BWPC
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3088
  • Fax: 217-383-4565
Mailing address:
  • Phone: 217-383-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-116368
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036116368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: