Healthcare Provider Details

I. General information

NPI: 1548614431
Provider Name (Legal Business Name): OLUSEUN OSINOWO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 N SAWYER AVE STE 1
CHICAGO IL
60625-5211
US

IV. Provider business mailing address

6930 S SOUTH SHORE DR APT 724
CHICAGO IL
60649-1887
US

V. Phone/Fax

Practice location:
  • Phone: 872-292-9958
  • Fax:
Mailing address:
  • Phone: 773-997-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277001223
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.001223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: