Healthcare Provider Details

I. General information

NPI: 1356339790
Provider Name (Legal Business Name): HANSERS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 RING RD
CALUMET CITY IL
60409-5459
US

IV. Provider business mailing address

1473 RING RD
CALUMET CITY IL
60409-5459
US

V. Phone/Fax

Practice location:
  • Phone: 708-862-8156
  • Fax: 708-862-8159
Mailing address:
  • Phone: 708-862-8156
  • Fax: 708-862-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ADEYEMI OLUDARE FATOKI
Title or Position: ATTENDING PHYSICIAN
Credential: M.D
Phone: 708-862-8156