Provider Demographics
NPI:1215109327
Name:E.Z.FIAKPUI, M.D., M.S., S.C.
Entity type:Organization
Organization Name:E.Z.FIAKPUI, M.D., M.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-731-2700
Mailing Address - Street 1:2315 E 93RD ST STE 337
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3948
Mailing Address - Country:US
Mailing Address - Phone:773-731-2700
Mailing Address - Fax:773-731-8687
Practice Address - Street 1:2315 E 93RD ST STE 337
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3948
Practice Address - Country:US
Practice Address - Phone:773-731-2700
Practice Address - Fax:773-731-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21603450OtherBLUECROSS/BLUESHIELD
IL21603450OtherBLUECROSS/BLUESHIELD
ILD12484Medicare UPIN