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General NPI Number Information
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NPI Number | 1114284411
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Entity Type | Individual
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Provider Name | OLAOLUWA OLADIPO FAYANJU MD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 10553 SAINT CLAIR AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-1973
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Country | US
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Telephone | 216-682-7702
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Fax | 216-920-6273
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Provider Business Mailing Address
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Address Line | 30 W MONROE ST STE 1200
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City | CHICAGO
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State | IL
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Zip | 60603-2420
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036138589
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35134072
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License Number State | OH
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