MEDICARE: ANTHONY OYETOLA NP

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	2090135518	IL

General Provider Information

NPI Number	:	1922472968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY OYETOLA NP

Provider Business Mailing Address
First Line	:	16 EAST 17TH PLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628
Country	:	US
Telephone Number	:	773-716-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 E 117TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-5543
Country	:	US
Telephone Number	:	773-716-8766
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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