Provider Demographics
NPI:1073111365
Name:ABAYOMI, OPEYEMI O
Entity Type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:O
Last Name:ABAYOMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1746
Mailing Address - Country:US
Mailing Address - Phone:773-263-1612
Mailing Address - Fax:844-859-3979
Practice Address - Street 1:27 NORTH ST STE G
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1248
Practice Address - Country:US
Practice Address - Phone:773-263-1612
Practice Address - Fax:844-859-3979
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider