Provider Demographics
NPI:1881420636
Name:OGUNJIMI, ADEDEJI A
Entity type:Individual
Prefix:
First Name:ADEDEJI
Middle Name:A
Last Name:OGUNJIMI
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 1:1414 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2031
Mailing Address - Country:US
Mailing Address - Phone:847-877-4880
Mailing Address - Fax:
Practice Address - Street 1:1414 OAKTON ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2031
Practice Address - Country:US
Practice Address - Phone:847-877-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
ILO25200170054172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)