Provider Demographics
NPI:1376305003
Name:ILESANMI, OLUMIDE SILAS
Entity Type:Individual
Prefix:MR
First Name:OLUMIDE
Middle Name:SILAS
Last Name:ILESANMI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OLUMIDE
Other - Middle Name:SILAS
Other - Last Name:ADEDEJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 BALTIMORE BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7071
Mailing Address - Country:US
Mailing Address - Phone:443-653-3918
Mailing Address - Fax:
Practice Address - Street 1:909 BALTIMORE BLVD STE 151
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7071
Practice Address - Country:US
Practice Address - Phone:443-653-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251C00000X, 251E00000X, 251G00000X, 3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider