Provider Demographics
NPI:1639584279
Name:OSAWE, FAITHFUL OSAREKPAMA (MD)
Entity Type:Individual
Prefix:
First Name:FAITHFUL
Middle Name:OSAREKPAMA
Last Name:OSAWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAITHFUL
Other - Middle Name:OSAREKPAMA
Other - Last Name:IGHALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7733 171ST PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3260
Mailing Address - Country:US
Mailing Address - Phone:773-738-4756
Mailing Address - Fax:
Practice Address - Street 1:20201 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-679-2160
Practice Address - Fax:708-679-2161
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125065751390200000X
IL036142779208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine