Provider Demographics
NPI:1629136551
Name:ANYANWU, JOVITA C (MD)
Entity Type:Individual
Prefix:
First Name:JOVITA
Middle Name:C
Last Name:ANYANWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16734 STEEPLECHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5890
Mailing Address - Country:US
Mailing Address - Phone:708-256-8886
Mailing Address - Fax:
Practice Address - Street 1:16734 STEEPLECHASE PKWY
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5890
Practice Address - Country:US
Practice Address - Phone:708-256-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI02590Medicare UPIN