Provider Demographics
NPI:1427622232
Name:ADEYEMI, ISAAC (NP)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:ADEYEMI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22858 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2531
Mailing Address - Country:US
Mailing Address - Phone:773-759-1297
Mailing Address - Fax:
Practice Address - Street 1:22858 MILLARD AVE
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2531
Practice Address - Country:US
Practice Address - Phone:773-759-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty