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1164154878
OMOVAUDO DIVINE OMO-EBOH
CHICAGO, IL
NPI
1164154878
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Former Name
FATIMA OGAR-EGBOR
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: IL 125.081017)
Enumeration Date
2022-06-30
Last Update Date
2022-06-30
Business Address
OMOVAUDO DIVINE OMO-EBOH MD
1625 E 75TH ST
CHICAGO, IL 60649-3603
Phone number: 773-947-7313
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Mailing Address
OMOVAUDO DIVINE OMO-EBOH MD
1625 E 75TH ST
CHICAGO, IL 60649-3603
Phone number: 773-947-7313
Copy
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