MEDICARE: BOLA ADOJUTELEGAN

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	164W00000X	Licensed Practical Nurse	043129212	IL

General Provider Information

NPI Number	:	1265137376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOLA ADOJUTELEGAN

Provider Business Mailing Address
First Line	:	5639 N CENTRAL AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6454
Country	:	US
Telephone Number	:	312-647-9857
Fax Number	:

Provider Business Practice Location Address
First Line	:	5639 N CENTRAL AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6454
Country	:	US
Telephone Number	:	312-647-9857
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	12/16/2024

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Directions to “ BOLA ADOJUTELEGAN ” Practice Location

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