Provider Demographics
NPI:1962452193
Name:OGANWU, RITA N (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:N
Last Name:OGANWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203030 S. CRAWFORD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-922-9170
Mailing Address - Fax:708-922-9180
Practice Address - Street 1:203030 S. CRAWFORD AVE STE 110
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-922-9170
Practice Address - Fax:708-922-9180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL774850Medicare ID - Type Unspecified
ILD16366Medicare UPIN