Provider Demographics
NPI:1649641747
Name:AKAEZE, DOROTHY MATO
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MATO
Last Name:AKAEZE
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 1:100 W 162ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2003
Mailing Address - Country:US
Mailing Address - Phone:708-730-2200
Mailing Address - Fax:708-210-0625
Practice Address - Street 1:100 W 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2003
Practice Address - Country:US
Practice Address - Phone:708-730-2200
Practice Address - Fax:708-210-0625
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009004A363LF0000X
IL209013426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily