Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 021.003085 | IL |
NPI | 1053980607 |
---|---|
Provider Name | Dr. Abayomi Olusoji Akintorin |
First Address | Oak Brook, IL 60523-1736 |
Second Address | Chicago, IL 60603-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |