Provider Demographics
NPI:1790313203
Name:AKINROTIMI, OLATOYOSI GRACE (MPH, PA-C)
Entity Type:Individual
Prefix:
First Name:OLATOYOSI
Middle Name:GRACE
Last Name:AKINROTIMI
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6908
Mailing Address - Country:US
Mailing Address - Phone:773-995-6300
Mailing Address - Fax:
Practice Address - Street 1:1029 E 130TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6908
Practice Address - Country:US
Practice Address - Phone:773-995-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant