Provider Demographics
NPI:1497056659
Name:CALDWELL, EBONIE
Entity Type:Individual
Prefix:MS
First Name:EBONIE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E OHIO ST
Mailing Address - Street 2:SUITE 1621
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3262
Mailing Address - Country:US
Mailing Address - Phone:312-523-9084
Mailing Address - Fax:
Practice Address - Street 1:211 E OHIO ST
Practice Address - Street 2:SUITE 1621
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3262
Practice Address - Country:US
Practice Address - Phone:312-523-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health