Healthcare Provider Details

I. General information

NPI: 1407419872
Provider Name (Legal Business Name): OLUSOLA A ORIMOLOYE MBBS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 2200
CHICAGO IL
60611-3370
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 7-353
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-3278
  • Fax: 312-926-6344
Mailing address:
  • Phone: 312-695-0070
  • Fax: 312-695-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036160353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: