Provider Demographics
NPI:1245718600
Name:ULOGO, CHUKWUDI UZOR (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:CHUKWUDI
Middle Name:UZOR
Last Name:ULOGO
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2432
Mailing Address - Country:US
Mailing Address - Phone:773-979-1979
Mailing Address - Fax:773-409-5047
Practice Address - Street 1:3349 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2432
Practice Address - Country:US
Practice Address - Phone:773-979-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL271635793001Medicaid