Provider Demographics
NPI:1760485007
Name:AKINTILO, OLATUNJI R (MD)
Entity Type:Individual
Prefix:DR
First Name:OLATUNJI
Middle Name:R
Last Name:AKINTILO
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 1:1701 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2670
Mailing Address - Country:US
Mailing Address - Phone:815-935-9394
Mailing Address - Fax:815-935-1187
Practice Address - Street 1:1701 E COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2670
Practice Address - Country:US
Practice Address - Phone:815-935-9394
Practice Address - Fax:815-935-1187
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37594207P00000X, 207Q00000X
IL036094325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094325Medicaid
IL4632039OtherBC
WI32231400Medicaid
G25551Medicare UPIN
WI0017Medicare PIN
IL4632039OtherBC