Provider Demographics
NPI:1497702732
Name:AROWOLO, IBRAHIM O
Entity Type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:O
Last Name:AROWOLO
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 1:235 REMINGTON BLVD
Mailing Address - Street 2:STE I
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3687
Mailing Address - Country:US
Mailing Address - Phone:630-312-8022
Mailing Address - Fax:630-312-8660
Practice Address - Street 1:879 BROMPTON CIR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1493
Practice Address - Country:US
Practice Address - Phone:708-642-2128
Practice Address - Fax:630-759-5458
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ37847Medicare UPIN
ILK15359Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID NO