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Individual

AINA ADEDOYIN ADEGBEMI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3118 W DEVON AVE APT 1E, CHICAGO, IL 60659-1458
(773) 407-9065
Mailing address
3118 W DEVON AVE APT 1E, CHICAGO, IL 60659-1458
(773) 407-9065

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00000000
NON
01
00000000001
NON
01
T46000175712
STATE IDENTIFICATION NUMBER
IL
Enumeration date
05/30/2018
Last updated
05/30/2018
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