Basic Information
| Provider Information | |||||||||
| NPI: | 1811920036 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EZE | ||||||||
| FirstName: | EMEKA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2231 E. 95TH STREET | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737687700 | ||||||||
| FaxNumber: | 7737687768 | ||||||||
| Practice Location | |||||||||
| Address1: | 2231 E. 95TH STREET | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737687700 | ||||||||
| FaxNumber: | 7737687768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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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 | 036-114419 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.