Provider Demographics
NPI:1427884469
Name:AIYEMBO, ROTIMI DAVID
Entity type:Individual
Prefix:
First Name:ROTIMI
Middle Name:DAVID
Last Name:AIYEMBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GABRIELLE LN UNIT 6062
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-4302
Mailing Address - Country:US
Mailing Address - Phone:773-681-1478
Mailing Address - Fax:
Practice Address - Street 1:3900 GABRIELLE LN UNIT 6062
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60598-4302
Practice Address - Country:US
Practice Address - Phone:773-681-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily