Provider Demographics
NPI:1922365105
Name:OBAJULUWA, ADEMOLA ADEBUKOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEMOLA
Middle Name:ADEBUKOLA
Last Name:OBAJULUWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ADEMOLA
Other - Last Name:OBAJULUWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3710 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1400
Mailing Address - Country:US
Mailing Address - Phone:219-670-9435
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1416082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology