Provider Demographics
NPI:1609150713
Name:ABAYOMI ADEYEMI MD SC
Entity type:Organization
Organization Name:ABAYOMI ADEYEMI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-261-8614
Mailing Address - Street 1:111 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W 59TH ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4969
Practice Address - Country:US
Practice Address - Phone:708-261-8614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084629261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084629Medicaid
335930Medicare PIN
IL036084629Medicaid