Provider Demographics
NPI:1447389994
Name:EZIKE, NGOZI OGBUNAMIRI (MD)
Entity Type:Individual
Prefix:DR
First Name:NGOZI
Middle Name:OGBUNAMIRI
Last Name:EZIKE
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:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-0292
Mailing Address - Country:US
Mailing Address - Phone:708-288-8222
Mailing Address - Fax:708-579-9573
Practice Address - Street 1:4800 W CHICAGO AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3223
Practice Address - Country:US
Practice Address - Phone:773-826-9600
Practice Address - Fax:773-826-9601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-108225207R00000X
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics