Basic Information
| Provider Information | |||||||||
| NPI: | 1588075626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EZEMA | ||||||||
| FirstName: | NONSO | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5241 W GALEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606394160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089413516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S FAIRFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735422000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125064376 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 28706 | WV | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.