Provider Demographics
NPI:1609939347
Name:OKEZIE, CHRISTIAN ENYINNA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ENYINNA
Last Name:OKEZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTIAN
Other - Middle Name:ENYINNA
Other - Last Name:OKEZIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3124 KATHLEEN LN
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1744
Mailing Address - Country:US
Mailing Address - Phone:773-291-0035
Mailing Address - Fax:773-291-0037
Practice Address - Street 1:972 E 133RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60827-1428
Practice Address - Country:US
Practice Address - Phone:773-291-0035
Practice Address - Fax:773-291-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056093Medicaid
IL036056093Medicaid