Individual
OLUSOJI TAIWO OYEDAPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17831 FAIROAKS DR, COUNTRY CLUB HILLS, IL 60478-2929
(773) 225-6904
Mailing address
17831 FAIROAKS DR, COUNTRY CLUB HILLS, IL 60478-2929
(773) 225-6904
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.128404
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-3820733
IRS
IL
Enumeration date
11/09/2020
Last updated
11/09/2020
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