Healthcare Provider Details

I. General information

NPI: 1659210367
Provider Name (Legal Business Name): UFAYO PATRICK ADESHINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 N ALPINE RD
LOVES PARK IL
61111-3107
US

IV. Provider business mailing address

4387 LODGEVIEW PL
DOUGLASVILLE GA
30135-8631
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-3397
  • Fax: 815-971-9795
Mailing address:
  • Phone: 404-936-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: