Healthcare Provider Details

I. General information

NPI: 1245359025
Provider Name (Legal Business Name): TUNJI LADIPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4200
US

IV. Provider business mailing address

45 W 111TH ST
CHICAGO IL
60628-4200
US

V. Phone/Fax

Practice location:
  • Phone: 773-995-3000
  • Fax:
Mailing address:
  • Phone: 773-995-3195
  • Fax: 773-681-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-056167
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036-056167
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number36-056157
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number036-056167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: