1407419872 NPI number — DR. OLUSOLA AYODEJI ORIMOLOYE MBBS, MPH

Table of content: DR. OLUSOLA AYODEJI ORIMOLOYE MBBS, MPH (NPI 1407419872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407419872 NPI number — DR. OLUSOLA AYODEJI ORIMOLOYE MBBS, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORIMOLOYE
Provider First Name:
OLUSOLA
Provider Middle Name:
AYODEJI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407419872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
676 N SAINT CLAIR ST STE 7-353
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-695-0070
Provider Business Mailing Address Fax Number:
312-695-1903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E HURON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-695-0070
Provider Business Practice Location Address Fax Number:
312-695-1903
Provider Enumeration Date:
04/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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