Provider Demographics
NPI:1174573828
Name:ANWULI OKOLI MD,INC
Entity type:Organization
Organization Name:ANWULI OKOLI MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANWULI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-391-5383
Mailing Address - Street 1:PO BOX 6212
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-6212
Mailing Address - Country:US
Mailing Address - Phone:847-672-6478
Mailing Address - Fax:
Practice Address - Street 1:200 S GREENLEAF ST
Practice Address - Street 2: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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100619207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79821Medicare UPIN