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General NPI Number Information
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NPI Number | 1447374780
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Entity Type | Individual
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Provider Name | MS. GRACE EYO EKONG
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 6101 N SHERIDAN RD EAST SUITE 9B
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City | CHICAGO
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State | IL
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Zip | 60660-2880
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Country | US
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Telephone | 773-973-1236
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Fax | 773-974-6157
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Provider Business Mailing Address
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Address Line | 6101 N. SHERIDAN RD EAST EAST POINT BUILDING, SUITE 9B
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City | CHICAGO
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State | IL
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Zip | 60660-2880
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Country | US
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Telephone | 773-973-1236
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Fax | 773-974-6157
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1168939
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License Number State | IL
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