Healthcare Provider Details

I. General information

NPI: 1720712680
Provider Name (Legal Business Name): JAMES AKINDUNBI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19710 GOVERNORS HWY STE 5-1189
FLOSSMOOR IL
60422-2080
US

IV. Provider business mailing address

19710 GOVERNORS HWY STE 5-1189
FLOSSMOOR IL
60422-2080
US

V. Phone/Fax

Practice location:
  • Phone: 224-258-4014
  • Fax:
Mailing address:
  • Phone: 773-551-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277.002923
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number277.002923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: