Provider Demographics
NPI:1295489045
Name:ABIDEMI, EMMANUEL OLASEYI
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:OLASEYI
Last Name:ABIDEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 N BROADWAY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5011
Mailing Address - Country:US
Mailing Address - Phone:312-498-0779
Mailing Address - Fax:
Practice Address - Street 1:4623 N BROADWAY ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5011
Practice Address - Country:US
Practice Address - Phone:312-498-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker