Provider Demographics
NPI:1952458895
Name:OLADEJO, OMOTAYO SUNDAY (MHS)
Entity Type:Individual
Prefix:MR
First Name:OMOTAYO
Middle Name:SUNDAY
Last Name:OLADEJO
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 W 98TH PL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2614
Mailing Address - Country:US
Mailing Address - Phone:708-291-0079
Mailing Address - Fax:708-857-9417
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:708-291-0079
Practice Address - Fax:708-857-9417
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA2741KD1Medicaid
IL515000Other1
IL234943Other1
IL0001634317Other1