Provider Demographics
NPI:1144372194
Name:OGUEJIOFOR, IKECHUKWU (MD)
Entity type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:
Last Name:OGUEJIOFOR
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 1:10400 SOUTHWEST HWY # LL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1367
Mailing Address - Country:US
Mailing Address - Phone:708-888-8287
Mailing Address - Fax:
Practice Address - Street 1:10400 S0UTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415
Practice Address - Country:US
Practice Address - Phone:708-888-8287
Practice Address - Fax:708-423-8659
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23994208800000X
IL036123737208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
211475Medicare PIN