Provider Demographics
NPI:1669079018
Name:OYEBODE, ISMAIL ADEBAYO (APN)
Entity type:Individual
Prefix:
First Name:ISMAIL
Middle Name:ADEBAYO
Last Name:OYEBODE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4809
Mailing Address - Country:US
Mailing Address - Phone:773-517-3183
Mailing Address - Fax:630-756-2769
Practice Address - Street 1:11000 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3909
Practice Address - Country:US
Practice Address - Phone:773-517-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily