Provider Demographics
NPI:1063404382
Name:OKONKWO, ADAORA MARGO (MD)
Entity type:Individual
Prefix:DR
First Name:ADAORA
Middle Name:MARGO
Last Name:OKONKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S MILWAUKEE AVE
Mailing Address - Street 2:CONDELL MEDICAL CENTER, DEPT OF PATHOLOGY
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3204
Mailing Address - Country:US
Mailing Address - Phone:847-990-5155
Mailing Address - Fax:847-918-0713
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:CONDELL MEDICAL CENTER, DEPT OF PATHOLOGY
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-990-5155
Practice Address - Fax:847-918-0713
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100663207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100663Medicaid
ILH48086Medicare ID - Type Unspecified