Provider Demographics
NPI:1346281110
Name:AKHIGBE, CLARA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:AKHIGBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 REGENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:773-962-0633
Mailing Address - Fax:773-994-2174
Practice Address - Street 1:6307 S STEWART AVE STE 313
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-962-0633
Practice Address - Fax:773-994-2174
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085642208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085642Medicaid
IL21623216OtherBLUE CROSS BLUE SHIELD