=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457121246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BABAJIDE IDOWU ADELEYE APN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4050 HEALTHWAY DR STE 140
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504-8184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-409-5117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARLTON AT THE LAKE REHABILITATION CENTER 725 W MONTROSE AVENUE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-929-1700
-----------------------------------------------------
Fax | 773-929-3068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 041425108
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------