Healthcare Provider Details

I. General information

NPI: 1023229283
Provider Name (Legal Business Name): WASIU O ARIYO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 S JEFFERY BLVD STE A
CHICAGO IL
60649-2176
US

IV. Provider business mailing address

4930 PHEASANT CT
SCHERERVILLE IN
46375-3384
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-0526
  • Fax:
Mailing address:
  • Phone: 219-472-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: