Provider Demographics
NPI:1417632407
Name:IRUOLAGBE, CHRISTOPHER OJEMIEGA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:OJEMIEGA
Last Name:IRUOLAGBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 KING FAISAL LBN ABDUL AZIZ RD
Mailing Address - Street 2:
Mailing Address - City:AL QUNFUDAH
Mailing Address - State:MAKKAH
Mailing Address - Zip Code:28821
Mailing Address - Country:SA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY ROAD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-578-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2024-03-19
Deactivation Date:2024-01-25
Deactivation Code:
Reactivation Date:2024-03-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program