Provider Demographics
NPI:1720534316
Name:ADEOTI, TOBI (NP)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:
Last Name:ADEOTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FLETCHER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-931-8900
Mailing Address - Fax:847-931-9041
Practice Address - Street 1:750 FLETCHER DR STE 200
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-931-8900
Practice Address - Fax:847-931-9041
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH134705363LA2200X
IL209016546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health