MEDICARE: DR. OTUONYE E ONYEWUCHI MD, MPH

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
1	207P00000X	Emergency Medicine Physician	36118945	IL
2	208M00000X	Hospitalist Physician	036118945	IL
3	207R00000X	Internal Medicine Physician	036-118945	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36118945	OTHER	IL	MEDICAL LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01065422A	OTHER	IN	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1538354295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OTUONYE E ONYEWUCHI MD, MPH

Provider Business Mailing Address
First Line	:	1750 E 87TH ST
Second Line	:	SUITE 109
City	:	CHICAGO
State	:	IL
Zip	:	60617-2713
Country	:	US
Telephone Number	:	773-933-9300
Fax Number	:	773-933-9302

Provider Business Practice Location Address
First Line	:	1750 E 87TH ST
Second Line	:	SUITE 109
City	:	CHICAGO
State	:	IL
Zip	:	60617-2713
Country	:	US
Telephone Number	:	773-933-9300
Fax Number	:	773-933-9302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	11/10/2020

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