Provider Demographics
NPI:1730567512
Name:BALOGUN, FEYINTOLU MORAYO (DPM)
Entity type:Individual
Prefix:
First Name:FEYINTOLU
Middle Name:MORAYO
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 S LARAMIE AVE UNIT 50646
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-5147
Mailing Address - Country:US
Mailing Address - Phone:708-628-4520
Mailing Address - Fax:773-847-4467
Practice Address - Street 1:1406 S CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:708-628-4520
Practice Address - Fax:773-847-4467
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003872213ES0103X
IL016005873213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery