Provider Demographics
NPI:1962923318
Name:OGUNLEYE, MORRIS TUNDE
Entity type:Individual
Prefix:MR
First Name:MORRIS
Middle Name:TUNDE
Last Name:OGUNLEYE
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 1:8 LAKE PLUMLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5025
Mailing Address - Country:US
Mailing Address - Phone:224-600-8171
Mailing Address - Fax:
Practice Address - Street 1:8 LAKE PLUMLEIGH CT
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5025
Practice Address - Country:US
Practice Address - Phone:224-600-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL82-1772333Medicaid