Provider Demographics
NPI:1093701575
Name:ORONSAYE, OSARETIN (MD)
Entity Type:Individual
Prefix:
First Name:OSARETIN
Middle Name:
Last Name:ORONSAYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 W OGDEN AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1647
Mailing Address - Country:US
Mailing Address - Phone:773-522-6100
Mailing Address - Fax:773-257-2527
Practice Address - Street 1:2653 W OGDEN AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-522-6100
Practice Address - Fax:773-257-2527
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097639207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70538Medicare UPIN
K04342Medicare ID - Type Unspecified