Provider Demographics
NPI:1043266471
Name:OYETUNDE LTD
Entity Type:Organization
Organization Name:OYETUNDE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:OYETUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-261-1200
Mailing Address - Street 1:5301 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4040
Mailing Address - Country:US
Mailing Address - Phone:773-261-1200
Mailing Address - Fax:773-261-1212
Practice Address - Street 1:2901 W 159TH ST
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-4051
Practice Address - Country:US
Practice Address - Phone:708-333-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25013Medicare ID - Type Unspecified
ILD89263Medicare UPIN