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General NPI Number Information
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NPI Number | 1053595918
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Entity Type | Organization
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Legal Business Name | CROSS ROAD OBSTETRICS AND GYNECOLOGY CLINIC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 3724 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60651-3820
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Country | US
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Telephone | 773-486-3300
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Fax | 773-486-3071
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Provider Business Mailing Address
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Address Line | P.O. BOX 5111
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City | OAKBROOK
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State | IL
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Zip | 60522-5111
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Country | US
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Telephone | 773-486-3300
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Fax | 773-486-3071
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TOCHUKWU O ONYEKWULUJE
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Credential | M.D.
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Telephone | 773-486-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036094748
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License Number State | IL
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