Provider Demographics
NPI:1184910382
Name:ILO, SHERIFFDEEN OLALEKAN (DO)
Entity type:Individual
Prefix:DR
First Name:SHERIFFDEEN
Middle Name:OLALEKAN
Last Name:ILO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:SHERIFF
Other - Middle Name:
Other - Last Name:ILO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:111 GOLDEN LEAF CV
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-8026
Mailing Address - Country:US
Mailing Address - Phone:281-773-8779
Mailing Address - Fax:
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1320207R00000X
TXR5138207R00000X
LA332306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine