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Organization

GREAT HEIGHTS OTP

Active
Parent organization
GREAT HEIGHTS OTP
Other names
Great Heights Family Medicine, Ottawa NTP, Great Heights OTP Ottawa
Organization subpart
Yes

Provider details

NPI number
Legal business name
GREAT HEIGHTS OTP
Authorized official
ADEYEMI FATOKI MD (OWNER)
(312) 952-9378
Entity
Organization

Contact information

Practice address
315 E MCKINLEY RD, OTTAWA, IL 61350-4805
(815) 434-0228
Mailing address
315 E MCKINLEY RD, OTTAWA, IL 61350-4805
(815) 434-0228

Taxonomy

Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A-6548-0002-A
SUPR
IL
Enumeration date
01/06/2017
Last updated
12/19/2019
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