Provider Demographics
NPI:1851312979
Name:NWAFOR, OLUWATOYIN M (MD)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:M
Last Name:NWAFOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUWATOYIN
Other - Middle Name:
Other - Last Name:ADEYEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4573
Mailing Address - Fax:312-864-9496
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4573
Practice Address - Fax:312-864-9496
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097175207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK10896Medicare UPIN