MEDICARE: DR. CHINOMSO MORDI 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
1	207R00000X	Internal Medicine Physician	036-133512	IL

General Provider Information

NPI Number	:	1740501485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINOMSO MORDI M.D

Provider Business Mailing Address
First Line	:	8475 GREEN ALDER CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3679
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1347 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2924
Country	:	US
Telephone Number	:	773-865-9154
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/03/2024

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