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General NPI Number Information
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NPI Number | 1114106978
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Entity Type | Organization
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Legal Business Name | OSAFO HEALTH CARE CLINIC INC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 215 REMINGTON BLVD STE G2
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3663
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Country | US
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Telephone | 630-226-0162
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Fax | 630-226-0160
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Provider Business Mailing Address
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Address Line | 215 REMINGTON BLVD STE G2
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3663
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Country | US
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Telephone | 630-226-0162
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Fax | 630-226-0160
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Authorized Official
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Title or Position | PRESIDENT
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Name | SETH K OSAFO
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Credential | M.D.
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Telephone | 309-690-3369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036099549
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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