Provider Demographics
NPI:1275360851
Name:ADEXBRA HEALTHCARE LLC
Entity type:Organization
Organization Name:ADEXBRA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADETOMIWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETILEWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-909-3328
Mailing Address - Street 1:205 N MICHIGAN AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5902
Mailing Address - Country:US
Mailing Address - Phone:708-517-0508
Mailing Address - Fax:
Practice Address - Street 1:205 N MICHIGAN AVE STE 810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5902
Practice Address - Country:US
Practice Address - Phone:708-517-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty