MEDICARE: UCHE OLEKANMA M.D S.C

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	036114328	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11581877	OTHER	IL	CAQH
2	1821287871	OTHER	IL	NPI NUMBER
3	5566-0185	OTHER	IL	ILLINOIS IBT
4	20014750	OTHER	IL	IL PCP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	22001745P03	OTHER		PLICA
7	036114328	OTHER	IL	PROFESSIONAL LICENCE
8	14D1075800	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1821287871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCHE OLEKANMA M.D S.C

Provider Business Mailing Address
First Line	:	8201 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4626
Country	:	US
Telephone Number	:	773-873-3434
Fax Number	:	773-873-0208

Provider Business Practice Location Address
First Line	:	8201 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4626
Country	:	US
Telephone Number	:	773-873-3434
Fax Number	:	773-873-0208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. UCHENNA OLEKANMA
Credential	:	M.D
Telephone Number	:	773-863-5162

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	03/07/2023

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