Provider Demographics
NPI:1225761117
Name:KAYODE, MOJISOLA A
Entity Type:Individual
Prefix:
First Name:MOJISOLA
Middle Name:A
Last Name:KAYODE
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 1:1325 HOWARD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3788
Mailing Address - Country:US
Mailing Address - Phone:847-868-8464
Mailing Address - Fax:847-905-0396
Practice Address - Street 1:1325 HOWARD ST STE 301
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3788
Practice Address - Country:US
Practice Address - Phone:847-868-8464
Practice Address - Fax:847-905-0396
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000738374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL812166362201Medicaid