Provider Demographics
NPI:1184162646
Name:OPAKUNLE, OYEWOLE
Entity type:Individual
Prefix:
First Name:OYEWOLE
Middle Name:
Last Name:OPAKUNLE
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 1:921 FIELDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2917
Mailing Address - Country:US
Mailing Address - Phone:708-691-4978
Mailing Address - Fax:
Practice Address - Street 1:921 FIELDSIDE DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2917
Practice Address - Country:US
Practice Address - Phone:708-691-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043104618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse