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General NPI Number Information
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NPI Number | 1487490389
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Entity Type | Individual
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Provider Name | CHIMAMAKA CAMELA IKORO MD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 2900 N LAKE SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60657-5640
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Country | US
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Telephone | 773-665-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E DELAWARE PL APT 702
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City | CHICAGO
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State | IL
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Zip | 60611-1936
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Country | US
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Telephone | 732-763-8780
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125083891
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License Number State | IL
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