Provider Demographics
NPI:1932132685
Name:DAWODU, ADEYOSOYE (MD)
Entity Type:Individual
Prefix:
First Name:ADEYOSOYE
Middle Name:
Last Name:DAWODU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3592
Mailing Address - Country:US
Mailing Address - Phone:309-268-3589
Mailing Address - Fax:309-268-2536
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:309-268-3589
Practice Address - Fax:309-268-2536
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113848208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00478520OtherRAILROAD MEDICARE
IN000000549806OtherANTHEM
IN200890360Medicaid
IL36113848Medicaid
ILI41232Medicare UPIN
ILK20828Medicare ID - Type Unspecified
IN000000549806OtherANTHEM