Basic Information
| Provider Information | |||||||||
| NPI: | 1386962389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKWUOSA | ||||||||
| FirstName: | IKE | ||||||||
| MiddleName: | STANLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 S. MICHIGAN AVE | ||||||||
| Address2: | APT #308 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105250289 | ||||||||
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| Practice Location | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126952458 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036132446 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 036132446 | IL | Y |
No ID Information.