Provider Demographics
NPI:1083590830
Name:OGBOZOR, CHISOM
Entity type:Individual
Prefix:
First Name:CHISOM
Middle Name:
Last Name:OGBOZOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 W WARREN BLVD UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2258
Mailing Address - Country:US
Mailing Address - Phone:815-302-4581
Mailing Address - Fax:
Practice Address - Street 1:2226 W WARREN BLVD UNIT G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2258
Practice Address - Country:US
Practice Address - Phone:815-302-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028497261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy