Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036083467 | IL |
NPI | 1063413755 |
---|---|
Provider Name | Dr. Tinuola Adeyanju |
First Address | Oak Park, IL 60304-1215 |
Second Address | Chicago, IL 60629-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 15/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G06363 | (02) | IL |