Provider Demographics
NPI:1063552479
Name:OSOWO, AYODELE (MD)
Entity type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:
Last Name:OSOWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HIGHLANDER BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1163
Mailing Address - Country:US
Mailing Address - Phone:817-468-7200
Mailing Address - Fax:817-468-7201
Practice Address - Street 1:15300 WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4686
Practice Address - Country:US
Practice Address - Phone:708-226-2870
Practice Address - Fax:708-226-2315
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2702207RG0100X
AZ37303207RI0008X
IL036170056207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CW357OtherBCBS
AZZ116956Medicare PIN