Provider Demographics
NPI:1093021917
Name:MARIUS O MOKWE MD.SC.
Entity Type:Organization
Organization Name:MARIUS O MOKWE MD.SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIUS
Authorized Official - Middle Name:OBIESIE
Authorized Official - Last Name:MOKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-695-7320
Mailing Address - Street 1:901 CENTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2104
Mailing Address - Country:US
Mailing Address - Phone:847-695-7320
Mailing Address - Fax:847-695-7732
Practice Address - Street 1:901 CENTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-695-7320
Practice Address - Fax:847-695-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094619207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110221774OtherPALMETO GBO
IL036094619Medicaid
IL12121881OtherONE HEALTH PLAN
IL0004525452OtherBLUE CROSS BLUE SHEILD
IL7953002OtherAETNA
IL0004525452OtherBLUE CROSS BLUE SHEILD