Provider Demographics
NPI:1518412741
Name:OLOPO, ELUSEGUN (DPT)
Entity type:Individual
Prefix:
First Name:ELUSEGUN
Middle Name:
Last Name:OLOPO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MARGATE TER APT 1C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3824
Mailing Address - Country:US
Mailing Address - Phone:773-556-8569
Mailing Address - Fax:
Practice Address - Street 1:900 W MARGATE TER APT 1C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3824
Practice Address - Country:US
Practice Address - Phone:773-556-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist