Provider Demographics
NPI:1295970085
Name:CHIDUME, ONYEKWELU EDWARD
Entity type:Individual
Prefix:
First Name:ONYEKWELU
Middle Name:EDWARD
Last Name:CHIDUME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S HYDE PARK BLVD
Mailing Address - Street 2:#904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5829
Mailing Address - Country:US
Mailing Address - Phone:708-305-2730
Mailing Address - Fax:
Practice Address - Street 1:17450 S. HALSTED AVE
Practice Address - Street 2:STE 260
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-799-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist