Provider Demographics
NPI:1538354295
Name:ONYEWUCHI, OTUONYE E (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:OTUONYE
Middle Name:E
Last Name:ONYEWUCHI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E 87TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2713
Mailing Address - Country:US
Mailing Address - Phone:773-933-9300
Mailing Address - Fax:773-933-9302
Practice Address - Street 1:1750 E 87TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2713
Practice Address - Country:US
Practice Address - Phone:773-933-9300
Practice Address - Fax:773-933-9302
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36118945207P00000X
IL036118945208M00000X
IL036-118945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36118945OtherMEDICAL LICENSE NUMBER
IL036118945Medicaid
IN01065422AOtherMEDICAL LICENSE NUMBER
IL833160002Medicare PIN