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General NPI Number Information
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NPI Number | 1235621772
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Entity Type | Individual
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Provider Name | OLUWARANTI AINA OSITELU MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 4440 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone | 708-684-5375
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Fax |
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Provider Business Mailing Address
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Address Line | 501 N CAPITOL AVE UNIT 4109
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1437
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Country | US
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Telephone | 317-224-9592
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01085972A
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License Number State | IN
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