Healthcare Provider Details

I. General information

NPI: 1861211682
Provider Name (Legal Business Name): DR. SOLOMON AJAYI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E JUNIPER LN
MOUNT PROSPECT IL
60056-1421
US

IV. Provider business mailing address

1105 E JUNIPER LN
MOUNT PROSPECT IL
60056-1421
US

V. Phone/Fax

Practice location:
  • Phone: 773-507-5127
  • Fax: 847-503-9089
Mailing address:
  • Phone: 773-507-5127
  • Fax: 847-503-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: