Provider Demographics
NPI:1871097949
Name:UMEBUANI, LOLA OLADINI (MD/MBA)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:OLADINI
Last Name:UMEBUANI
Suffix:
Gender:F
Credentials:MD/MBA
Other - Prefix:
Other - First Name:OLUFUNMILOLA
Other - Middle Name:KOFOWOROLA
Other - Last Name:OLADINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD/MBA
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2501
Mailing Address - Country:US
Mailing Address - Phone:217-838-3311
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:309-467-2371
Practice Address - Fax:309-467-2963
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361698272085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound