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NPI Code Detail

MEDICARE: OLUWASOORE OLUWATONI AKANDE DO

MEDICARE: OLUWASOORE OLUWATONI AKANDE DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics Physician036165701IL

General Provider Information

NPI Number : 1063917953
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUWASOORE OLUWATONI AKANDE DO
Provider Business Mailing Address
First Line : 800 E 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4906
Country : US
Telephone Number : 773-795-2260
Fax Number :
Provider Business Practice Location Address
First Line : 6250 S COTTAGE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-2530
Country : US
Telephone Number : 773-702-2193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2018
Last Update Date : 07/27/2023

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