Provider Demographics
NPI:1821390865
Name:OBIKILI, KENNETH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:OBIKILI
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408963
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8963
Mailing Address - Country:US
Mailing Address - Phone:773-510-6115
Mailing Address - Fax:
Practice Address - Street 1:941 W WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5754
Practice Address - Country:US
Practice Address - Phone:773-510-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.383413163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse