Healthcare Provider Details

I. General information

NPI: 1275360851
Provider Name (Legal Business Name): ADEXBRA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MICHIGAN AVE STE 810
CHICAGO IL
60601-5902
US

IV. Provider business mailing address

205 N MICHIGAN AVE STE 810
CHICAGO IL
60601-5902
US

V. Phone/Fax

Practice location:
  • Phone: 309-262-9924
  • Fax:
Mailing address:
  • Phone: 309-262-9924
  • Fax: 469-373-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADETOMIWA ADETILEWA
Title or Position: CEO
Credential:
Phone: 309-262-9924