Healthcare Provider Details

I. General information

NPI: 1811627029
Provider Name (Legal Business Name): ADESUWA OMONE IGHODARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W. 95TH STREET SUITE 200
OAK LAWN IL
60453
US

IV. Provider business mailing address

4220 W. 95TH STREET SUITE 200
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 708-398-0287
  • Fax: 708-684-2032
Mailing address:
  • Phone: 708-398-0287
  • Fax: 708-684-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125081030
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01095815A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: