Healthcare Provider Details

I. General information

NPI: 1871097949
Provider Name (Legal Business Name): LOLA OLADINI UMEBUANI MD/MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUFUNMILOLA KOFOWOROLA OLADINI MD/MBA

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE
NORMAL IL
61761-3592
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 309-467-2371
  • Fax: 309-467-2963
Mailing address:
  • Phone: 217-838-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036169827
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036169827
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: