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NPI Code Detail

MEDICARE: DR. IGONI INKO DOKUBO M.D.

MEDICARE: DR. IGONI INKO DOKUBO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianIL

General Provider Information

NPI Number : 1083608350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IGONI INKO DOKUBO M.D.
Provider Business Mailing Address
First Line : 3435 W VAN BUREN ST
Second Line : SUITE 028
City : CHICAGO
State : IL
Zip : 60624-3312
Country : US
Telephone Number : 773-265-0200
Fax Number : 773-265-8386
Provider Business Practice Location Address
First Line : 3435 W VAN BUREN ST
Second Line : SUITE 028
City : CHICAGO
State : IL
Zip : 60624-3312
Country : US
Telephone Number : 773-265-0200
Fax Number : 773-265-8386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 07/08/2007

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