Provider Demographics
NPI:1851300818
Name:AKINLADE, BOLANLE K (MD)
Entity Type:Individual
Prefix:DR
First Name:BOLANLE
Middle Name:K
Last Name:AKINLADE
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 1:617 AMES ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2613
Mailing Address - Country:US
Mailing Address - Phone:847-721-9326
Mailing Address - Fax:
Practice Address - Street 1:6 E PHILLIP RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1700
Practice Address - Country:US
Practice Address - Phone:847-680-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110791207PE0004X
CAA62834207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
K34491Medicare PIN