Provider Demographics
NPI:1275888703
Name:OLAITAN, OYEDOLAMU (MBBS, FACS, FEBS)
Entity Type:Individual
Prefix:DR
First Name:OYEDOLAMU
Middle Name:
Last Name:OLAITAN
Suffix:
Gender:M
Credentials:MBBS, FACS, FEBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 161
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-4252
Mailing Address - Fax:312-942-3055
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 161
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-4252
Practice Address - Fax:312-942-3055
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-130933204F00000X
IL036.130933208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology