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General NPI Number Information
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NPI Number | 1255695136
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Entity Type | Individual
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Provider Name | IBRAHIM ATSEJUWAWE USMAN-OYOWE M.D
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 LOMBARD ST GROUND FLR
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City | PHILADELPHIA
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State | PA
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Zip | 19146
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Country | US
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Telephone | 215-662-3259
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Fax | 215-615-3610
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125061518
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD456524
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License Number State | PA
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