=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609150713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABAYOMI ADEYEMI MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2011
-----------------------------------------------------
Last Update Date | 10/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 W 59TH ST
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-4969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-261-8614
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 W 59TH ST
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-4969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ABAYOMI ADEYEMI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 708-261-8614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 036084629
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------