Provider Demographics
NPI:1326323494
Name:ADELEKE, JOHNSON O
Entity Type:Individual
Prefix:MR
First Name:JOHNSON
Middle Name:O
Last Name:ADELEKE
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 1:387 LUELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2207
Mailing Address - Country:US
Mailing Address - Phone:708-868-8551
Mailing Address - Fax:708-868-8551
Practice Address - Street 1:387 LUELLA AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2207
Practice Address - Country:US
Practice Address - Phone:708-868-8551
Practice Address - Fax:708-868-8551
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL67809629343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)