Provider Demographics
NPI:1003994955
Name:ROPHEKA MEDICAL SERVICE LTD
Entity Type:Organization
Organization Name:ROPHEKA MEDICAL SERVICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TAIWO
Authorized Official - Last Name:OLATUNBOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-214-5300
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-0745
Mailing Address - Country:US
Mailing Address - Phone:708-214-5300
Mailing Address - Fax:773-913-2314
Practice Address - Street 1:551 W 103RD ST
Practice Address - Street 2:1ST FLOOR EAST WING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2403
Practice Address - Country:US
Practice Address - Phone:773-779-9890
Practice Address - Fax:773-779-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicaid