Healthcare Provider Details

I. General information

NPI: 1598740466
Provider Name (Legal Business Name): GABRIEL BOLADELE ROSANWO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 HALIGUS RD
HUNTLEY IL
60142-9553
US

IV. Provider business mailing address

10400 HALIGUS RD
HUNTLEY IL
60142-9553
US

V. Phone/Fax

Practice location:
  • Phone: 815-356-2323
  • Fax: 847-802-7201
Mailing address:
  • Phone: 815-356-2323
  • Fax: 847-802-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036104578
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036104578
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01080180A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: