MEDICARE: AMINAT YEWANDE OSUJI DDS

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	1223G0001X	General Practice Dentistry	4331895	IL

General Provider Information

NPI Number	:	1578185716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINAT YEWANDE OSUJI DDS

Provider Business Mailing Address
First Line	:	920 S CLAREMONT AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-5126
Country	:	US
Telephone Number	:	708-559-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 CHURCH ST STE 200W
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4578
Country	:	US
Telephone Number	:	847-448-1684
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	11/09/2022

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