Provider Demographics
NPI:1538975545
Name:BOBADE, ADEOLA BAMIDELE
Entity type:Individual
Prefix:
First Name:ADEOLA
Middle Name:BAMIDELE
Last Name:BOBADE
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 1:17752 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6199
Mailing Address - Country:US
Mailing Address - Phone:312-877-6951
Mailing Address - Fax:
Practice Address - Street 1:17752 HOLLY CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6199
Practice Address - Country:US
Practice Address - Phone:312-877-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHF193152278H0200X
ILHF13915374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health