Provider Demographics
NPI:1063413755
Name:ADEYANJU, TINUOLA (MD)
Entity type:Individual
Prefix:DR
First Name:TINUOLA
Middle Name:
Last Name:ADEYANJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 S OAK PARK AVE
Mailing Address - Street 2:2
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1215
Mailing Address - Country:US
Mailing Address - Phone:708-386-4980
Mailing Address - Fax:
Practice Address - Street 1:2519W 59TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1103
Practice Address - Country:US
Practice Address - Phone:773-434-1061
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083467207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG06363Medicare UPIN