Provider Demographics
NPI:1629079488
Name:UZOKWE, KEKE S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEKE
Middle Name:S
Last Name:UZOKWE
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 1:167 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1032
Mailing Address - Country:US
Mailing Address - Phone:708-351-9743
Mailing Address - Fax:
Practice Address - Street 1:167 N MARION ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1032
Practice Address - Country:US
Practice Address - Phone:708-351-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111657174400000X
IN208M00000208M00000X
IN01061346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000480318OtherANTHEM
IN200810890Medicaid
IN200810890Medicaid
IN940640JJJMedicare PIN