Healthcare Provider Details

I. General information

NPI: 1811887359
Provider Name (Legal Business Name): BENJAMIN O. ADEBOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6195 MARCELLA BLVD
HOBART IN
46342-0040
US

IV. Provider business mailing address

20128 DRIFTWOOD AVE
LYNWOOD IL
60411-6811
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71016805A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: