Healthcare Provider Details

I. General information

NPI: 1376724898
Provider Name (Legal Business Name): OSASUMWEN O. OSAYIMWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD STE 3001A
GLENVIEW IL
60026
US

IV. Provider business mailing address

2100 PFINGSTEN RD STE 3001A
GLENVIEW IL
60026-1301
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5840
  • Fax: 847-657-5732
Mailing address:
  • Phone: 847-657-5840
  • Fax: 847-657-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036121023
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036121023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: