Provider Demographics
NPI:1801895701
Name:ONYIBOR, KATE ANAYOCHUKWU (MD)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ANAYOCHUKWU
Last Name:ONYIBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:746 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1424
Mailing Address - Country:US
Mailing Address - Phone:224-357-6997
Mailing Address - Fax:224-227-7312
Practice Address - Street 1:746 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1424
Practice Address - Country:US
Practice Address - Phone:224-357-6997
Practice Address - Fax:224-227-7312
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107699207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-107699Medicaid
TN4122129OtherBCBST
TNI15749Medicare UPIN
TN3334871Medicare PIN
TNTN0120OtherJOHN DEERE HEALTHCARE