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NPI Code Detail

MEDICARE: MR. OGBONNAYA E ANEZIOKORO MD

MEDICARE:  MR. OGBONNAYA E ANEZIOKORO  MD
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
1207RN0300XNephrology PhysicianIL

General Provider Information

NPI Number : 1104831668
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OGBONNAYA E ANEZIOKORO MD
Provider Business Mailing Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-262-4556
Fax Number : 773-521-1017
Provider Business Practice Location Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-262-4556
Fax Number : 773-521-1017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 03/07/2023

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Directions to “ MR. OGBONNAYA E ANEZIOKORO MD” Practice Location

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