Active NPI
Elijah Ezeofor
- Public Health & General Preventive Medicine Physician
- Chicago, IL
National Provider Identifier
1063722049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- HDE1158
- Practice address
- 2133 W Lexington St
2ND Floor Chicago Dept. of Public Helath
Chicago, IL 60612-3707 - Phone
- (312) 746-4664
- Fax
- (312) 746-6526
- NPI assigned
- Oct 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | HDE1158 | IL | Primary |
Addresses
Primary practice location
2133 W Lexington St
2ND Floor Chicago Dept. of Public Helath
Chicago, IL 60612-3707
Mailing address
2133 West Lexington Street
2ND Floor Chicago Dept. of Health
Chicago, IL 60612
Phone (312) 746-4664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HDE1158 | Other | IL | RISK ASSESSOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HDE1158 | IL | MD | Public Health & General Preventive Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287014400000",
"number": "1063722049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2133 WEST LEXINGTON STREET",
"address_2": "2ND FLOOR CHICAGO DEPT. OF HEALTH",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-746-4664",
"fax_number": "312-746-6526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2133 W LEXINGTON ST",
"address_2": "2ND FLOOR CHICAGO DEPT. OF PUBLIC HELATH",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123707",
"telephone_number": "312-746-4664",
"fax_number": "312-746-6526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZEOFOR",
"first_name": "ELIJAH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-08",
"last_updated": "2010-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "IL",
"license": "HDE1158",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RISK ASSESSOR",
"identifier": "HDE1158",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.