Healthcare Provider Details

I. General information

NPI: 1790848315
Provider Name (Legal Business Name): ABAYOMI AKINTORIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST SUITE # 5670
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

14 HEATHER LN
OAK BROOK IL
60523-1736
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-3237
  • Fax: 312-864-9635
Mailing address:
  • Phone: 312-864-3237
  • Fax: 312-864-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-081534
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036-081534
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036-081534
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-081534
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036-081534
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: