Provider Demographics
NPI:1427222884
Name:OMOTOSHO, WURAOLA IBIYEMI (MD)
Entity type:Individual
Prefix:DR
First Name:WURAOLA
Middle Name:IBIYEMI
Last Name:OMOTOSHO
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 1:102 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:IL
Mailing Address - Zip Code:60927-9501
Mailing Address - Country:US
Mailing Address - Phone:815-694-2044
Mailing Address - Fax:
Practice Address - Street 1:102 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:IL
Practice Address - Zip Code:60927-9501
Practice Address - Country:US
Practice Address - Phone:815-694-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120926207R00000X
IL125047954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology