Provider Demographics
NPI:1467129734
Name:LIFEFLOW LLC
Entity Type:Organization
Organization Name:LIFEFLOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OBIDIKE
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:NWAKUDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-701-0998
Mailing Address - Street 1:PO BOX 3335
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3335
Mailing Address - Country:US
Mailing Address - Phone:630-701-0998
Mailing Address - Fax:
Practice Address - Street 1:1415 W 22ND STREET
Practice Address - Street 2:TOWER FLOOR
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-6052
Practice Address - Country:US
Practice Address - Phone:630-447-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty