Provider Demographics
NPI:1922597186
Name:ISHADIMU, AMINAT ABISOLA
Entity Type:Individual
Prefix:
First Name:AMINAT
Middle Name:ABISOLA
Last Name:ISHADIMU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4949
Mailing Address - Country:US
Mailing Address - Phone:708-203-0309
Mailing Address - Fax:
Practice Address - Street 1:530 E 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2326
Practice Address - Country:US
Practice Address - Phone:708-825-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator