Healthcare Provider Details

I. General information

NPI: 1851312979
Provider Name (Legal Business Name): OLUWATOYIN M NWAFOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUWATOYIN ADEYEMI MD

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST 12TH FLOOR
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

1900 W POLK ST 12TH FLOOR
CHICAGO IL
60612-3723
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4573
  • Fax: 312-864-9496
Mailing address:
  • Phone: 312-864-4573
  • Fax: 312-864-9496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-097175
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: