Provider Demographics
NPI:1962486274
Name:SOWADE, OLALEKAN (MD)
Entity Type:Individual
Prefix:
First Name:OLALEKAN
Middle Name:
Last Name:SOWADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 W 177TH ST STE 3G
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2199
Mailing Address - Country:US
Mailing Address - Phone:708-798-1200
Mailing Address - Fax:708-798-8141
Practice Address - Street 1:3330 W 177TH ST STE 3G
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2199
Practice Address - Country:US
Practice Address - Phone:708-798-1200
Practice Address - Fax:708-798-8141
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095861207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG63068Medicare UPIN