Provider Demographics
NPI:1760449938
Name:FATOKI, ADEYEMI OLUDARE (MD)
Entity type:Individual
Prefix:DR
First Name:ADEYEMI
Middle Name:OLUDARE
Last Name:FATOKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 RING RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5459
Mailing Address - Country:US
Mailing Address - Phone:708-862-8156
Mailing Address - Fax:708-862-8105
Practice Address - Street 1:315 E MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4805
Practice Address - Country:US
Practice Address - Phone:815-434-0228
Practice Address - Fax:815-434-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60259-20207Q00000X, 2083A0300X
AZ649812083A0300X
IL0360847292083A0300X
IN01062968A2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF05633Medicare UPIN