Healthcare Provider Details

I. General information

NPI: 1558765164
Provider Name (Legal Business Name): SULAIMON KEHINDE OLADIPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 S WESTERN AVE STE 206
CHICAGO IL
60643-6700
US

IV. Provider business mailing address

9415 S WESTERN AVE STE 206
CHICAGO IL
60643-6700
US

V. Phone/Fax

Practice location:
  • Phone: 773-301-8464
  • Fax: 773-530-2643
Mailing address:
  • Phone: 773-301-8464
  • Fax: 773-530-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1011663
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209034652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: