Provider Demographics
NPI:1942347075
Name:ERYTHRO MEDICAL & URGENT CARE CENTER
Entity Type:Organization
Organization Name:ERYTHRO MEDICAL & URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:773-660-1635
Mailing Address - Street 1:PO BOX 286057
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 EAST 103 STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2713
Practice Address - Country:US
Practice Address - Phone:773-660-1635
Practice Address - Fax:773-660-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047948A207Q00000X, 207R00000X, 208D00000X
IL207Q00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G49682Medicare UPIN
247470Medicare ID - Type Unspecified