Healthcare Provider Details

I. General information

NPI: 1508329707
Provider Name (Legal Business Name): MR. OLUWAMAYOWA JOHN OGINNI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W ARTHUR AVE
CHICAGO IL
60645-5544
US

IV. Provider business mailing address

47 W POLK ST STE 100249
CHICAGO IL
60605-2000
US

V. Phone/Fax

Practice location:
  • Phone: 773-654-3206
  • Fax:
Mailing address:
  • Phone: 773-751-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: