Provider Demographics
NPI:1427222884
Name:OMOTOSHO, WURAOLA IBIYEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:WURAOLA
Middle Name:IBIYEMI
Last Name:OMOTOSHO
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-0000
Mailing Address - Country:US
Mailing Address - Phone:630-914-2417
Mailing Address - Fax:630-914-2499
Practice Address - Street 1:656 N CONVENT
Practice Address - Street 2:#C
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-0000
Practice Address - Country:US
Practice Address - Phone:815-936-5167
Practice Address - Fax:815-937-8246
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036120926207R00000X
IL125047954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology