Provider Demographics
NPI:1821287871
Name:UCHE OLEKANMA M.D S.C
Entity Type:Organization
Organization Name:UCHE OLEKANMA M.D S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-863-5162
Mailing Address - Street 1:8201 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4626
Mailing Address - Country:US
Mailing Address - Phone:773-873-3434
Mailing Address - Fax:773-873-0208
Practice Address - Street 1:8201 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4626
Practice Address - Country:US
Practice Address - Phone:773-873-3434
Practice Address - Fax:773-873-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11581877OtherCAQH
IL1821287871OtherNPI NUMBER
IL5566-0185OtherILLINOIS IBT
IL20014750OtherIL PCP
IL036114328Medicaid
22001745P03OtherPLICA
IL036114328OtherPROFESSIONAL LICENCE
IL14D1075800OtherCLIA
IL14D1075800OtherCLIA
BO9500566OtherDEA NUMBER
IL152345Medicare UPIN