Provider Demographics
NPI:1063042844
Name:ADEYEMI, OLAYEMI EKAETTE
Entity Type:Individual
Prefix:
First Name:OLAYEMI
Middle Name:EKAETTE
Last Name:ADEYEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22858 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2531
Mailing Address - Country:US
Mailing Address - Phone:773-387-1700
Mailing Address - Fax:
Practice Address - Street 1:450 W 14TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2463
Practice Address - Country:US
Practice Address - Phone:708-985-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily