Provider Demographics
NPI:1700672961
Name:ADEDOJA, ADEBOWALE
Entity type:Individual
Prefix:
First Name:ADEBOWALE
Middle Name:
Last Name:ADEDOJA
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 1:672 LAKEVIEW DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5386
Mailing Address - Country:US
Mailing Address - Phone:312-721-4561
Mailing Address - Fax:
Practice Address - Street 1:672 LAKEVIEW DR UNIT 1
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5386
Practice Address - Country:US
Practice Address - Phone:312-721-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043134090164W00000X
332BC3200X, 332BN1400X, 332BP3500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition