Healthcare Provider Details

I. General information

NPI: 1386193464
Provider Name (Legal Business Name): ADEKUNLE ADENIJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 46TH PL
CHICAGO IL
60653-4205
US

IV. Provider business mailing address

525 E 46TH PL
CHICAGO IL
60653-4205
US

V. Phone/Fax

Practice location:
  • Phone: 773-507-8609
  • Fax:
Mailing address:
  • Phone: 773-507-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number041400848
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: