Healthcare Provider Details

I. General information

NPI: 1770467300
Provider Name (Legal Business Name): KIKELOMO IFEOLU OGUNDIPE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W. PETERSON AVENUE SUITE T10
CHICAGO IL
60659
US

IV. Provider business mailing address

3525 W. PETERSON AVENUE SUITE T10
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 630-222-7555
  • Fax: 630-333-4598
Mailing address:
  • Phone: 630-222-7555
  • Fax: 630-333-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number041.579919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: