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General NPI Number Information
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NPI Number | 1285192112
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Entity Type | Individual
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Provider Name | KOBINA ODOOM
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Gender | Male
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 207
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City | CHICAGO
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State | IL
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Zip | 60612-3988
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Country | US
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Telephone | 312-942-5861
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 DARTMOUTH DR
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City | BARTLETT
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State | IL
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Zip | 60103-7514
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Country | US
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Telephone | 773-403-0338
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.018292
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License Number State | IL
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