Organization
DR MEDA PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IZUCHUKWU NWAFO (CEO)
(708) 378-8079
Entity
Organization
Contact information
Practice address
1215 N HUMPHREY AVE, OAK PARK, IL 60302-1111
(708) 378-8079
Mailing address
1215 N HUMPHREY AVE, OAK PARK, IL 60302-1111
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
036119419
IL
405300000X
Prevention Professional
—
—
Other
Enumeration date
04/26/2017
Last updated
04/26/2017
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