Provider Demographics
NPI:1356506786
Name:BURNHAM MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:BURNHAM MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NWANNEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-206-0290
Mailing Address - Street 1:1515 DUNFRIES ST
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4386
Mailing Address - Country:US
Mailing Address - Phone:708-206-0290
Mailing Address - Fax:866-261-3402
Practice Address - Street 1:1515 DUNFRIES ST
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4386
Practice Address - Country:US
Practice Address - Phone:708-206-0290
Practice Address - Fax:866-261-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102719Medicaid