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General NPI Number Information
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NPI Number | 1316116619
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Entity Type | Organization
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Legal Business Name | IMPACT FAMILY HEALTH CARE, LTD.
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST SUITE 305
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City | CHICAGO
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State | IL
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Zip | 60657-5188
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Country | US
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Telephone | 773-404-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 W HOWARD ST
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City | CHICAGO
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State | IL
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Zip | 60645-2113
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Country | US
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Telephone | 773-398-8380
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN GAYL EKWUEME
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Credential | MD
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Telephone | 773-398-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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