Healthcare Provider Details

I. General information

NPI: 1063413755
Provider Name (Legal Business Name): TINUOLA ADEYANJU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519W 59TH ST
CHICAGO IL
60629-1103
US

IV. Provider business mailing address

741 S OAK PARK AVE 2
OAK PARK IL
60304-1215
US

V. Phone/Fax

Practice location:
  • Phone: 773-434-1061
  • Fax:
Mailing address:
  • Phone: 708-386-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036083467
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: