# DR MEDA PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679008734
- **Authorized official:** IZUCHUKWU NWAFO (CEO)
- **Authorized official phone:** (708) 378-8079

## Contact information

- **Practice address:** 1215 N HUMPHREY AVE, OAK PARK, IL 60302-1111
- **Practice address phone:** (708) 378-8079
- **Mailing address:** 1215 N HUMPHREY AVE, OAK PARK, IL 60302-1111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 036119419 | IL | Yes |
| 405300000X | Prevention Professional | — | NULL | — |
| 405300000X | Prevention Professional | — | — | — |

## Other

- **Enumeration date:** 04/26/2017
- **Last updated:** 04/26/2017