Individual
DR. BENEDICTA UMORU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5032 N ILLINOIS ST, STE B, FAIRVIEW HEIGHTS, IL 62208-3415
(618) 416-9005
(618) 641-9452
Mailing address
PO BOX 2015, FAIRVIEW HEIGHTS, IL 62208-0215
(618) 355-9970
(618) 355-9972
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036100162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100162
—
IL
01
—
08232145
BCBS IL
—
01
—
P00248272
RR MEDICARE
—
Enumeration date
07/20/2006
Last updated
05/13/2016
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