Healthcare Provider Details

I. General information

NPI: 1831756568
Provider Name (Legal Business Name): MORIYIKE O AKINOSUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S660 MIDWEST RD STE 100
OAKBROOK TERRACE IL
60181-4459
US

IV. Provider business mailing address

1S660 MIDWEST RD STE 100
OAKBROOK TERRACE IL
60181-4459
US

V. Phone/Fax

Practice location:
  • Phone: 630-478-0880
  • Fax:
Mailing address:
  • Phone: 630-478-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number036.177118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: