Provider Demographics
NPI:1922364918
Name:MARY DEAN-ONAYEMI,M.D.
Entity Type:Organization
Organization Name:MARY DEAN-ONAYEMI,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEAN-ONAYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-238-2282
Mailing Address - Street 1:1701 W MONTEREY AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4257
Mailing Address - Country:US
Mailing Address - Phone:773-238-2282
Mailing Address - Fax:773-238-5746
Practice Address - Street 1:1701 W MONTEREY AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4257
Practice Address - Country:US
Practice Address - Phone:773-238-2282
Practice Address - Fax:773-238-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065557261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036 065557Medicaid