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General NPI Number Information
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NPI Number | 1780002352
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND INFECTIOUS DISEASE PC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 430 E 162ND ST #487
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 312-504-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 430 E 162ND ST #487
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-960-4280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLUFEMI ABOYEJI
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Credential | MD
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Telephone | 708-960-4280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036119718
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License Number State | IL
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