Provider Demographics
NPI:1730474552
Name:OLUSANYA, ADEBAYO OYEKUNLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBAYO
Middle Name:OYEKUNLE
Last Name:OLUSANYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-6000
Mailing Address - Fax:
Practice Address - Street 1:4301 N MESA ST STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1118
Practice Address - Country:US
Practice Address - Phone:915-542-2352
Practice Address - Fax:915-593-8559
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
07993058OtherECFMG