Healthcare Provider Details

I. General information

NPI: 1972711513
Provider Name (Legal Business Name): OLATOKUNBO SHOBANDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLATOKUNBO OYEJOLA M.D.

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506-1449
US

IV. Provider business mailing address

881 FINLEY DR
AURORA IL
60504-8160
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.135549
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number40319
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54420-020
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036135549
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036135549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: