Provider Demographics
NPI:1952804361
Name:ADELEKE, OLUKEMI M
Entity Type:Individual
Prefix:
First Name:OLUKEMI
Middle Name:M
Last Name:ADELEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 S INDIANA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4594
Mailing Address - Country:US
Mailing Address - Phone:301-346-1587
Mailing Address - Fax:
Practice Address - Street 1:650 WARRENVILLE RD STE 400
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4317
Practice Address - Country:US
Practice Address - Phone:630-725-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner