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General NPI Number Information
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NPI Number | 1194119123
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Entity Type | Individual
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Provider Name | HAWA BINDU FORKPA
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Gender | Female
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 4867 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-3603
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Country | US
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Telephone | 312-227-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E. CHICAGO AVE BOX 15
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City | CHICAGO
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State | IL
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Zip | 60611-2605
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Country | US
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Telephone | 312-227-4000
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125-067562
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License Number State | IL
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