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Individual

DR. OLUSEGUN ADEKUNLE ISHMAEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
30 W ERIE ST, UNIT 801, CHICAGO, IL 60654-2827
(312) 841-0083
(312) 475-0064
Mailing address
30 W ERIE ST, UNIT 801, CHICAGO, IL 60654-2827
(312) 841-0083
(312) 475-0064

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036126294
IL
207Q00000X
Family Medicine Physician
01047096A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010407096
STATE LICENSE
IN
Enumeration date
12/20/2006
Last updated
10/13/2020
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