Provider Demographics
NPI:1295032555
Name:MADUEKE-LAVEAUX, OBIANUJU SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:OBIANUJU
Middle Name:SANDRA
Last Name:MADUEKE-LAVEAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OBIANUJU
Other - Middle Name:SANDRA
Other - Last Name:MADUEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:773-702-1061
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC2050
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-834-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144211207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology