Provider Demographics
NPI:1538168620
Name:OKOLI, UZOMA (MD)
Entity type:Individual
Prefix:
First Name:UZOMA
Middle Name:
Last Name:OKOLI
Suffix:
Gender:M
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:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-6119
Mailing Address - Country:US
Mailing Address - Phone:847-672-6478
Mailing Address - Fax:847-672-7432
Practice Address - Street 1:200 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3398
Practice Address - Country:US
Practice Address - Phone:847-672-6478
Practice Address - Fax:847-672-7432
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109992261QM0801X
IL036-1099922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1366768772OtherHAWTHORN BEHAVIORAL HEALTH
IL212793OtherMEDICARE NUMBER
IL036109992Medicaid