Provider Demographics
NPI:1457517039
Name:OSAYIMWEN, UCHENNA NNEKA
Entity Type:Individual
Prefix:DR
First Name:UCHENNA
Middle Name:NNEKA
Last Name:OSAYIMWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2228
Mailing Address - Country:US
Mailing Address - Phone:847-367-5400
Mailing Address - Fax:847-367-4769
Practice Address - Street 1:1000 E ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:847-367-5400
Practice Address - Fax:847-367-4769
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics