Provider Demographics
NPI:1063071819
Name:ATOMORI, ABIODUN JOSEPHINE
Entity type:Individual
Prefix:
First Name:ABIODUN
Middle Name:JOSEPHINE
Last Name:ATOMORI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ABIODUN
Other - Middle Name:JOSEPHINE
Other - Last Name:ATOMORI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10522 S CICERO AVE STE 301D
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5200
Mailing Address - Country:US
Mailing Address - Phone:773-449-0400
Mailing Address - Fax:773-688-0339
Practice Address - Street 1:10522 S CICERO AVE STE 301D
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5200
Practice Address - Country:US
Practice Address - Phone:773-449-0400
Practice Address - Fax:773-688-0339
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.002157363LA2200X
IL209.019136363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health