Provider Demographics
NPI:1548614431
Name:OSINOWO, OLUSEUN
Entity type:Individual
Prefix:
First Name:OLUSEUN
Middle Name:
Last Name:OSINOWO
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 1:6930 S SOUTH SHORE DR
Mailing Address - Street 2:APT 724
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1887
Mailing Address - Country:US
Mailing Address - Phone:773-997-8757
Mailing Address - Fax:
Practice Address - Street 1:2250 E DEVON AVE
Practice Address - Street 2:SUITE #333
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4511
Practice Address - Country:US
Practice Address - Phone:224-803-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner