MEDICARE: BABAJIDE IDOWU ADELEYE APN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	041425108	IL

General Provider Information

NPI Number	:	1457121246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAJIDE IDOWU ADELEYE APN

Provider Business Mailing Address
First Line	:	CARLTON AT THE LAKE REHABILITATION CENTER
Second Line	:	725 W MONTROSE AVENUE
City	:	CHICAGO
State	:	IL
Zip	:	60613
Country	:	US
Telephone Number	:	773-929-1700
Fax Number	:	773-929-3068

Provider Business Practice Location Address
First Line	:	4050 HEALTHWAY DR STE 140
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8184
Country	:	US
Telephone Number	:	815-409-5117
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	04/11/2025

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