Healthcare Provider Details

I. General information

NPI: 1346602265
Provider Name (Legal Business Name): ADESOLA O BABALOLA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADESOLA O OKE FNP-BC

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 W TOUHY AVE
CHICAGO IL
60645-3008
US

IV. Provider business mailing address

1963 MCCRAREN RD
HIGHLAND PARK IL
60035-2228
US

V. Phone/Fax

Practice location:
  • Phone: 224-754-0344
  • Fax: 949-909-4542
Mailing address:
  • Phone: 618-698-3110
  • Fax: 949-909-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number248007430
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: