MEDICARE: OLAIDE ODUTAYO

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1881008720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAIDE ODUTAYO

Provider Business Mailing Address
First Line	:	2416 S GOEBBERT RD
Second Line	:	UNIT 2002
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5185
Country	:	US
Telephone Number	:	224-558-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 S GOEBBERT RD
Second Line	:	UNIT 2002
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5185
Country	:	US
Telephone Number	:	847-258-3198
Fax Number	:

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

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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Directions to “ OLAIDE ODUTAYO ” Practice Location

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