Provider Demographics
NPI:1063917953
Name:AKANDE, OLUWASOORE OLUWATONI (DO)
Entity type:Individual
Prefix:
First Name:OLUWASOORE
Middle Name:OLUWATONI
Last Name:AKANDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SOORE
Other - Middle Name:
Other - Last Name:AKANDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4906
Mailing Address - Country:US
Mailing Address - Phone:773-795-2260
Mailing Address - Fax:
Practice Address - Street 1:6250 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2530
Practice Address - Country:US
Practice Address - Phone:773-702-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036165701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program