Provider Demographics
NPI:1124550678
Name:OGUNSOLA, KAYODE BOLAJI
Entity Type:Individual
Prefix:
First Name:KAYODE
Middle Name:BOLAJI
Last Name:OGUNSOLA
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 1:7538 N RIDGE BLVD APT 3WEST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1115
Mailing Address - Country:US
Mailing Address - Phone:773-671-2324
Mailing Address - Fax:773-856-5666
Practice Address - Street 1:7538 N RIDGE BLVD APT 3WEST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1115
Practice Address - Country:US
Practice Address - Phone:773-671-2324
Practice Address - Fax:773-856-5666
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)