MEDICARE: DR. OLUKAYODE OLOWE MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01047948A	IN
2	207R00000X	Internal Medicine Physician	036094159	IL
3	208D00000X	General Practice Physician	036094159	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699941435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUKAYODE OLOWE MD PHD

Provider Business Mailing Address
First Line	:	123 EAST 103RD STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2713
Country	:	US
Telephone Number	:	773-660-1635
Fax Number	:	773-660-1638

Provider Business Practice Location Address
First Line	:	123 EAST 103RD STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-2713
Country	:	US
Telephone Number	:	773-660-1635
Fax Number	:	773-660-1638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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