Basic Information
| Provider Information | |||||||||
| NPI: | 1972711513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOBANDE | ||||||||
| FirstName: | OLATOKUNBO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OYEJOLA | ||||||||
| OtherFirstName: | OLATOKUNBO | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 35318 EAGLE WAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606781353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20201 CRAWFORD AVE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447404445 | ||||||||
| FaxNumber: | 7086792161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.135549 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 54420-020 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 40319 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 036135549 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 036135549 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.