Healthcare Provider Details

I. General information

NPI: 1508228594
Provider Name (Legal Business Name): OMOLOLA ALAKIJA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-200
CHICAGO IL
60611-5929
US

IV. Provider business mailing address

6819 BURNS ST APT E4
FOREST HILLS NY
11375-5072
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036149299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: