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General NPI Number Information
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NPI Number | 1073646113
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Entity Type | Individual
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Provider Name | KEIKO OKUMURA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1635 WEST CONGRESS PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-943-6370
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Fax | 312-943-6052
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Provider Business Mailing Address
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Address Line | 400 EAST SOUTH WATER ST APT 3001
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City | CHICAGO
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State | IL
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Zip | 60601
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Country | US
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Telephone | 734-476-7178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036122931
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License Number State | IL
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