Provider Demographics
NPI:1326355835
Name:OKWUOSA, TOCHUKWU M (DO)
Entity Type:Individual
Prefix:
First Name:TOCHUKWU
Middle Name:M
Last Name:OKWUOSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DARIEN CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3684
Mailing Address - Country:US
Mailing Address - Phone:312-942-6253
Mailing Address - Fax:312-942-5829
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-6253
Practice Address - Fax:312-942-5829
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.115485207RC0000X
MI5101019067207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630724Medicare PIN