Active NPI
Michael Mbagwu
- Ophthalmology Physician
- Chicago, IL
National Provider Identifier
1992196273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 125.068633
- Practice address
- 7435 W Talcott Ave
Presence Resurrection Medical Center
Chicago, IL 60631-3707 - Phone
- (937) 831-0237
- NPI assigned
- Feb 9, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 125.068633 | IL | Primary |
Addresses
Primary practice location
7435 W Talcott Ave
Presence Resurrection Medical Center
Chicago, IL 60631-3707
Mailing address
7435 W Talcott Ave
Presence Resurrection Medical Center
Chicago, IL 60631-3707
Phone (650) 725-9073
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.068633 | IL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1992196273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7435 W TALCOTT AVE",
"address_2": "PRESENCE RESURRECTION MEDICAL CENTER",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606313707",
"telephone_number": "650-725-9073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7435 W TALCOTT AVE",
"address_2": "PRESENCE RESURRECTION MEDICAL CENTER",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606313707",
"telephone_number": "937-831-0237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MBAGWU",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-09",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IL",
"license": "125.068633",
"primary": true
}
],
"identifiers": [],
"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 Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.