Provider Demographics
NPI:1497458145
Name:ABEGUNDE, OLASUMBO OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLASUMBO
Middle Name:OLUBUNMI
Last Name:ABEGUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-6000
Mailing Address - Country:US
Mailing Address - Phone:773-339-4188
Mailing Address - Fax:
Practice Address - Street 1:13508 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-7829
Practice Address - Country:US
Practice Address - Phone:815-596-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.033172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty