Provider Demographics
NPI:1891789665
Name:COKER, MOBOLANLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOBOLANLE
Middle Name:A
Last Name:COKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOBOLANLE
Other - Middle Name:A
Other - Last Name:OGUNLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:BOX 152
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-6903
Mailing Address - Fax:880-773-3068
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:OUTREACH PHYSICIAN SERVICES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-6903
Practice Address - Fax:773-880-3068
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF90688Medicare UPIN