Basic Information
| Provider Information | |||||||||
| NPI: | 1194119123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORKPA | ||||||||
| FirstName: | HAWA | ||||||||
| MiddleName: | BINDU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E. CHICAGO AVE BOX 15 | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122274000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4867 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606403603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122274000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125-067562 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.