Provider Demographics
NPI:1548234883
Name:EBIE, NYAMBI (MD)
Entity type:Individual
Prefix:MR
First Name:NYAMBI
Middle Name:
Last Name:EBIE
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 1:505 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 5811
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3427
Mailing Address - Country:US
Mailing Address - Phone:773-731-2982
Mailing Address - Fax:773-731-3328
Practice Address - Street 1:2301 E 93RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3913
Practice Address - Country:US
Practice Address - Phone:773-731-2982
Practice Address - Fax:773-731-3328
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045826207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1548234883OtherNPI - INDIVIDUAL
IN200165450AOtherPUBLIC AID - INDIANA
IN226920OtherINDIANA PTAN - INDIVIDUAL- NYAMBI EBIE
IL0001634652OtherBCBS - IL
IL036045826Medicaid
ININ1034OtherINDIANA PTAN ( GROUP ) CMGI
1376505065OtherCMGI NPI (GROUP)
IN201129370AOtherINDIANA PROVIDER # ( GROUP ) CMGI
ILK15828OtherLEGACY NUMBER
IL210946OtherILLINOIS PTAN ( GROUP) CMGI
IN000000347617OtherANTHEM- BCBS- INDIANA
ILP00190421OtherRAILROAD - IL
INP00285036OtherRAILROAD INDIANA
IL0001634652OtherBCBS - IL