Provider Demographics
NPI:1881793552
Name:ACHEBE, JAMES BOB (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BOB
Last Name:ACHEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3126
Mailing Address - Country:US
Mailing Address - Phone:773-785-9000
Mailing Address - Fax:773-785-9191
Practice Address - Street 1:10810 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3126
Practice Address - Country:US
Practice Address - Phone:773-785-9000
Practice Address - Fax:773-785-9191
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-054592207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606987OtherBLUE CROSS/SHIELD
IL793013234OtherRAIL ROAD MEDICARE
IL036 054592Medicaid
IL21606987OtherBLUE CROSS/SHIELD
IL793013234OtherRAIL ROAD MEDICARE