| Eoht LLC | |
|
1718 W North Shore Ave Apt 11 Chicago IL 60626-4030 | |
| (773) 997-8757 | |
| Not Available |
| Full Name | Eoht LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1718 W North Shore Ave Apt 11, Chicago, Illinois |
| Authorized Official Name and Position | Oluseun Osinowo (MEMBER) |
| Authorized Official Contact | 7739978757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eoht LLC 1718 W North Shore Ave Apt 11 Chicago IL 60626-4030 | Eoht LLC 1718 W North Shore Ave Apt 11 Chicago IL 60626-4030 Ph: (773) 997-8757 |
| NPI Number | 1003449612 |
|---|---|
| Provider Enumeration Date | 02/21/2020 |
| Last Update Date | 07/26/2021 |
| Certification Date | 07/26/2021 |
| Medicare PECOS PAC ID | 0547691974 |
|---|---|
| Medicare Enrollment ID | O20200519000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003449612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Secondary |
| Provider Name | Oluseun Osinowo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548614431 PECOS PAC ID: 6507164803 Enrollment ID: I20160420001307 |
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