Individual
AYOOLA SAMUEL AWOFADEJU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3703 BALLANTRAE WAY, FLOSSMOOR, IL 60422-4316
(708) 955-6415
Mailing address
3703 BALLANTRAE WAY, FLOSSMOOR, IL 60422-4316
(778) 708-4660
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01063569A
IN
207P00000X
Emergency Medicine Physician
Primary
036102150
IL
207R00000X
Internal Medicine Physician
036102150
IL
207R00000X
Internal Medicine Physician
27155
NV
207RH0003X
Hematology & Oncology Physician
036102150
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102150
—
IL
05
—
036102150-8
—
IL
05
—
200800750
—
IN
01
—
P00163002
RAILROAD MEDICARE
—
Enumeration date
06/10/2006
Last updated
02/04/2026
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