Basic Information
| Provider Information | |||||||||
| NPI: | 1275888703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLAITAN | ||||||||
| FirstName: | OYEDOLAMU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS, FACS, FEBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 W HARRISON ST | ||||||||
| Address2: | SUITE 161 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129424252 | ||||||||
| FaxNumber: | 3129423055 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 W HARRISON ST | ||||||||
| Address2: | SUITE 161 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129424252 | ||||||||
| FaxNumber: | 3129423055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 036-130933 | IL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 208800000X | 036.130933 | IL | N | Allopathic & Osteopathic Physicians | Urology |
No ID Information.