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General NPI Number Information
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NPI Number | 1922364918
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Entity Type | Organization
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Legal Business Name | MARY DEAN-ONAYEMI,M.D.
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 1701 W MONTEREY AVE SUITE 11
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City | CHICAGO
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State | IL
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Zip | 60643-4257
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Country | US
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Telephone | 773-238-2282
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Fax | 773-238-5746
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Provider Business Mailing Address
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Address Line | 1701 W MONTEREY AVE SUITE 11
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City | CHICAGO
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State | IL
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Zip | 60643-4257
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Country | US
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Telephone | 773-238-2282
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Fax | 773-238-5746
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MARY ANN DEAN-ONAYEMI
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Credential | M.D.
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Telephone | 773-238-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036-065557
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License Number State | IL
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