Individual
DR. OLUMIDE AYODEJI FANIYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS, MPH
Contact information
Practice address
1901 W HARRISON ST, DEPARTMENT OF PEDIATRICS, ADMINISTRATION BUILDING #1134, CHICAGO, IL 60612-3714
(312) 864-4505
Mailing address
1901 W HARRISON ST, DEPARTMENT OF PEDIATRICS, ADMINISTRATION BUILDING #1134, CHICAGO, IL 60612-3714
(312) 864-4505
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125069281
IL
Other
Enumeration date
06/09/2016
Last updated
06/15/2016
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