Provider Demographics
NPI:1740501485
Name:MORDI, CHINOMSO (MD)
Entity type:Individual
Prefix:DR
First Name:CHINOMSO
Middle Name:
Last Name:MORDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHINOMSO
Other - Middle Name:DAVID
Other - Last Name:MORDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8475 GREEN ALDER CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1347 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2924
Practice Address - Country:US
Practice Address - Phone:773-865-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-133512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine