Provider Demographics
NPI:1548512932
Name:OLAWUNI, FELICIA O (MD)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:O
Last Name:OLAWUNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W KENWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4379
Mailing Address - Country:US
Mailing Address - Phone:217-872-3800
Mailing Address - Fax:217-872-0849
Practice Address - Street 1:102 W KENWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4379
Practice Address - Country:US
Practice Address - Phone:217-872-3800
Practice Address - Fax:217-872-0849
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125085349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036061400Medicaid