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General NPI Number Information
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NPI Number | 1376662544
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Entity Type | Organization
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Legal Business Name | J. BOB ACHEBE MD SC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 10810 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-3126
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Country | US
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Telephone | 773-785-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 10810 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-3126
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Country | US
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Telephone | 773-785-9000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES BOB ACHEBE
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Credential | MD
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Telephone | 773-333-5782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 036054592
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License Number State | IL
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