Provider Demographics
NPI:1689254963
Name:ODIASE, SUNDAY OSAROBO
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:OSAROBO
Last Name:ODIASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22928 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-5955
Mailing Address - Country:US
Mailing Address - Phone:773-895-7063
Mailing Address - Fax:773-895-7063
Practice Address - Street 1:22928 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-5955
Practice Address - Country:US
Practice Address - Phone:773-895-7063
Practice Address - Fax:773-895-7063
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date: