Provider Demographics
NPI:1114811544
Name:OLAYIWOLA, MUTIAT OLAWUNMI
Entity type:Individual
Prefix:
First Name:MUTIAT
Middle Name:OLAWUNMI
Last Name:OLAYIWOLA
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 1:20789 DEXTER STREET
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411
Mailing Address - Country:US
Mailing Address - Phone:773-732-1821
Mailing Address - Fax:
Practice Address - Street 1:5116 N BIG HOLLOW RD STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3514
Practice Address - Country:US
Practice Address - Phone:309-674-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program