MEDICARE: DR. TINUOLA ADEYANJU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	036083467	IL

General Provider Information

NPI Number	:	1063413755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINUOLA ADEYANJU M.D.

Provider Business Mailing Address
First Line	:	741 S OAK PARK AVE
Second Line	:	2
City	:	OAK PARK
State	:	IL
Zip	:	60304-1215
Country	:	US
Telephone Number	:	708-386-4980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2519W 59TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-1103
Country	:	US
Telephone Number	:	773-434-1061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/15/2015

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