Provider Demographics
NPI:1760241459
Name:EGOLUM, UGOCHUKWU CRESENT (MD)
Entity Type:Individual
Prefix:
First Name:UGOCHUKWU
Middle Name:CRESENT
Last Name:EGOLUM
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 1:5445 S INGLESIDE AVE APT 222
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5010
Mailing Address - Country:US
Mailing Address - Phone:312-877-7434
Mailing Address - Fax:
Practice Address - Street 1:5445 S INGLESIDE AVE APT 222
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5010
Practice Address - Country:US
Practice Address - Phone:312-877-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00000000000000000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine