Basic Information
| Provider Information | |||||||||
| NPI: | 1285038703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWAL | ||||||||
| FirstName: | OLUSEYE | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 SANDRA DR | ||||||||
| Address2: | APT. 4 | ||||||||
| City: | UNIVERSITY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604842787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734599546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 W 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464021711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198854264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2014 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3104A0625X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | 3747P1801X | N | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.