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General NPI Number Information
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NPI Number | 1649203092
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Entity Type | Organization
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Legal Business Name | KORLE BU MEDICAL GROUP
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5517 S. ELLIS AVE
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-643-0400
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Fax | 773-643-0640
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Provider Business Mailing Address
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Address Line | 9033 RESERVE DR
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1655
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Country | US
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Telephone | 773-643-0400
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Fax | 773-643-0640
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ACQUAYE-AWAH
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Credential | M.D
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Telephone | 773-643-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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