| Integracare Clinic | |
|
1750 E 87th St Suite 109 Chicago IL 60617-2713 | |
| (773) 933-9300 | |
| (773) 933-9302 |
| Full Name | Integracare Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 1750 E 87th St, Chicago, Illinois |
| Authorized Official Name and Position | Otuonye Ezeribe Onyewuchi (PRESIDENT/CEO) |
| Authorized Official Contact | 7739339300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integracare Clinic Po Box 806112 Chicago IL 60680-4122 Ph: (773) 933-9300 | Integracare Clinic 1750 E 87th St Suite 109 Chicago IL 60617-2713 Ph: (773) 933-9300 |
| NPI Number | 1265739643 |
|---|---|
| Provider Enumeration Date | 02/19/2011 |
| Last Update Date | 11/10/2020 |
| Medicare PECOS PAC ID | 7719162122 |
|---|---|
| Medicare Enrollment ID | O20110429000125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265739643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036118945 (Illinois) | Primary |
| Provider Name | Otuonye E Onyewuchi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538354295 PECOS PAC ID: 0446312284 Enrollment ID: I20090102000410 |
| Provider Name | Victor C Okamgba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629434741 PECOS PAC ID: 8628372711 Enrollment ID: I20160210001753 |
| Provider Name | Oluseun Osinowo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548614431 PECOS PAC ID: 6507164803 Enrollment ID: I20160420001307 |
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