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General NPI Number Information
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NPI Number | 1215567599
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Entity Type | Individual
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Provider Name | RASAQ DUROJAIYE APRN
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Gender | Male
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Dates
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Enumeration Date | 01/25/2020
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Last Update Date | 01/25/2020
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Provider Practice Location Address
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Address Line | 17800 KEDZIE AVE
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City | HAZEL CREST
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State | IL
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Zip | 60429-2029
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Country | US
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Telephone | 708-213-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 805 CORNFIELD RD
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City | MATTESON
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State | IL
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Zip | 60443-2495
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Country | US
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Telephone | 773-263-5786
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209020297
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License Number State | IL
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