Provider Demographics
NPI:1457483265
Name:OMOSANYA, SAFIYA
Entity Type:Individual
Prefix:MRS
First Name:SAFIYA
Middle Name:
Last Name:OMOSANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAFIYA
Other - Middle Name:
Other - Last Name:KARIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 FRANCES LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4769
Mailing Address - Country:US
Mailing Address - Phone:708-296-7922
Mailing Address - Fax:
Practice Address - Street 1:9000 FRANCES LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4769
Practice Address - Country:US
Practice Address - Phone:708-296-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005754171W00000X
IL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor