Provider Demographics
NPI:1598832875
Name:ADUBIFA, OLAJUMOKE (MD)
Entity Type:Individual
Prefix:
First Name:OLAJUMOKE
Middle Name:
Last Name:ADUBIFA
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 1:120 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4215
Mailing Address - Country:US
Mailing Address - Phone:815-939-8661
Mailing Address - Fax:
Practice Address - Street 1:100 E JEFFERY ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-5018
Practice Address - Country:US
Practice Address - Phone:815-939-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098407207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4673170001OtherDMERC GROUP
ILP00444366/CK6882OtherMEDICARE RAILROAD
ILK47026/203980Medicare PIN
ILK47025/203979Medicare PIN