Provider Demographics
NPI:1053595918
Name:CROSS ROAD OBSTETRICS AND GYNECOLOGY CLINIC
Entity type:Organization
Organization Name:CROSS ROAD OBSTETRICS AND GYNECOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TOCHUKWU
Authorized Official - Middle Name:O
Authorized Official - Last Name:ONYEKWULUJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-486-3300
Mailing Address - Street 1:P.O. BOX 5111
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-5111
Mailing Address - Country:US
Mailing Address - Phone:773-486-3300
Mailing Address - Fax:773-486-3071
Practice Address - Street 1:3724 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3820
Practice Address - Country:US
Practice Address - Phone:773-486-3300
Practice Address - Fax:773-486-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG46348Medicare UPIN
IL207209Medicare PIN