Healthcare Provider Details

I. General information

NPI: 1881420636
Provider Name (Legal Business Name): ADEDEJI A OGUNJIMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 OAKTON ST
PARK RIDGE IL
60068-2031
US

IV. Provider business mailing address

1414 OAKTON ST
PARK RIDGE IL
60068-2031
US

V. Phone/Fax

Practice location:
  • Phone: 847-877-4880
  • Fax:
Mailing address:
  • Phone: 847-877-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberO25200170054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: