Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036-130933 | IL |
N | 208800000X | Urologist | 036.130933 | IL |
NPI | 1275888703 |
---|---|
Provider Name | Dr. Oyedolamu Olaitan |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 16/07/2014 |