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NPI Code Detail

MEDICARE: ADEKUNLE ADESUYI CRNA

MEDICARE: ADEKUNLE ADESUYI CRNA
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
1367500000XCertified Registered Nurse AnesthetistRN582611PA

General Provider Information

NPI Number : 1073757803
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADEKUNLE ADESUYI CRNA
Provider Business Mailing Address
First Line : 1412 W DIVISION ST APT 3
Second Line :
City : CHICAGO
State : IL
Zip : 60642-3323
Country : US
Telephone Number : 847-858-5276
Fax Number :
Provider Business Practice Location Address
First Line : 5645 W ADDISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2881
Country : US
Telephone Number : 773-282-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2009
Last Update Date : 02/14/2022

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Directions to “ ADEKUNLE ADESUYI CRNA” Practice Location

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