MEDICARE: IDAYAT ADEOLA ADEKUNLE FNP

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	363LF0000X	Family Nurse Practitioner	209013710	IL

General Provider Information

NPI Number	:	1427415207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDAYAT ADEOLA ADEKUNLE FNP

Provider Business Mailing Address
First Line	:	1165 N MILWAUKEE AVE
Second Line	:	APT. 609
City	:	CHICAGO
State	:	IL
Zip	:	60642-4098
Country	:	US
Telephone Number	:	773-370-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N MILWAUKEE AVE
Second Line	:	APT. 609
City	:	CHICAGO
State	:	IL
Zip	:	60642-4098
Country	:	US
Telephone Number	:	773-370-1539
Fax Number	:	773-377-6188

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

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	07/11/2016

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