Healthcare Provider Details

I. General information

NPI: 1386084077
Provider Name (Legal Business Name): ADETUNJI ADEGBOYEGA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE STE 325
AURORA IL
60504-5897
US

IV. Provider business mailing address

2020 OGDEN AVE STE 325
AURORA IL
60504-5894
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 215-500-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.064037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: