Provider Demographics
NPI:1801488952
Name:OYELAHAN, MICHAEL
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:OYELAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OPEYEMI
Other - Middle Name:
Other - Last Name:OYELAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21000 S FRANKFORT SQUARE RD STE M
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9386
Mailing Address - Country:US
Mailing Address - Phone:815-534-5813
Mailing Address - Fax:815-534-5816
Practice Address - Street 1:21000 S FRANKFORT SQUARE RD STE M
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9386
Practice Address - Country:US
Practice Address - Phone:815-534-5813
Practice Address - Fax:815-534-5816
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1881065480001Medicaid