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General NPI Number Information
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NPI Number | 1700335924
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Entity Type | Individual
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Provider Name | OLUMIDE ADEYEMO
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Gender | Male
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 4711 GOLF RD SUITE 1250
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 847-235-6033
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 WARWICK DR
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4149
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Country | US
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Telephone | 217-414-0854
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209.014922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209014922
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License Number State | IL
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