Healthcare Provider Details

I. General information

NPI: 1215662085
Provider Name (Legal Business Name): ADEYEMI KOBARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WEAVER PKWY
WARRENVILLE IL
60555-3919
US

IV. Provider business mailing address

1917 CRESTVIEW DR
PLAINFIELD IL
60586-4126
US

V. Phone/Fax

Practice location:
  • Phone: 708-953-5459
  • Fax:
Mailing address:
  • Phone: 708-953-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209025409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: