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General NPI Number Information
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NPI Number | 1326355835
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Entity Type | Individual
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Provider Name | TOCHUKWU M OKWUOSA D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST SUITE 1010
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-942-6253
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Fax | 312-942-5829
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Provider Business Mailing Address
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Address Line | 1600 DARIEN CLUB DR
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City | DARIEN
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State | IL
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Zip | 60561-3684
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Country | US
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Telephone | 312-942-6253
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Fax | 312-942-5829
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036.115485
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101019067
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License Number State | MI
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