Provider Demographics
NPI:1013651074
Name:OTULANA, RUKAYAT OLUBUNMI (MD)
Entity type:Individual
Prefix:
First Name:RUKAYAT
Middle Name:OLUBUNMI
Last Name:OTULANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 FEATHERSTONE RD # 250
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6303
Mailing Address - Country:US
Mailing Address - Phone:815-399-4404
Mailing Address - Fax:
Practice Address - Street 1:698 FEATHERSTONE RD # 250
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6303
Practice Address - Country:US
Practice Address - Phone:815-399-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2025-07-15
Deactivation Date:2023-01-30
Deactivation Code:
Reactivation Date:2023-02-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036175322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program