Individual
TIMOTHY OMOTAYO ADESANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
GRAHAM CORRECTIONAL CENTER, 12078 ILLINOIS RTE 185, HILLIBORO, IL 62049
(217) 532-6961
Mailing address
PO BOX 512, GREENVILLE, IL 62246-0512
(618) 664-2914
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085001089
IL
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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