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General NPI Number Information
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NPI Number | 1063048395
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Entity Type | Organization
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Legal Business Name | DR OUILIFE LLC
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 640 S FEDERAL ST APT 410
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City | CHICAGO
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State | IL
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Zip | 60605-1800
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Country | US
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Telephone | 205-790-3602
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S FEDERAL ST APT 410
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City | CHICAGO
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State | IL
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Zip | 60605-1800
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Country | US
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Telephone | 205-790-3602
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OUIDA L BROWN
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Credential | MD
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Telephone | 205-790-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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