Healthcare Provider Details

I. General information

NPI: 1134419096
Provider Name (Legal Business Name): OPEYEMI AJIKE ASANBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 815-395-9350
  • Fax: 815-395-9359
Mailing address:
  • Phone: 815-395-9350
  • Fax: 815-395-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036181517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: