Provider Demographics
NPI:1710093810
Name:AKINTORIN, MOPELOLA SUBUOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOPELOLA
Middle Name:SUBUOLA
Last Name:AKINTORIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOPELOLA
Other - Middle Name:SUBUOLA
Other - Last Name:AKINTORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3553
Practice Address - Fax:312-864-9941
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082438208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL73299Medicare ID - Type Unspecified
ILH04946Medicare UPIN