Provider Demographics
NPI:1336808666
Name:AFOLABI, OLADAPO AKINKUNMI
Entity Type:Individual
Prefix:
First Name:OLADAPO
Middle Name:AKINKUNMI
Last Name:AFOLABI
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 1:11987 BRUNSCHON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6036
Mailing Address - Country:US
Mailing Address - Phone:773-954-6854
Mailing Address - Fax:
Practice Address - Street 1:11987 BRUNSCHON LN
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6036
Practice Address - Country:US
Practice Address - Phone:773-954-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MCS-10-0008-0139OtherCERTIFIED OPERATOR CERTIFICATE OF ACHIEVEMENT