Isaac Kolawole Agboola, MD
Individual provider Active NPI Emergency Medicine Physician · Evanston, IL
NPI 1073018289 · NPPES record last updated Jul 29, 2022
Key facts
- NPI
- 1073018289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 036160081 (IL)
- Practice address
- 2650 Ridge Ave
Evanston, IL 60201-1700 - Phone
- (847) 570-2114
- Fax
- (847) 570-1223
- NPI assigned
- Mar 28, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220806000449 | IL | Practitioner - Emergency Medicine | 6305192147 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036160081 | IL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endeavor Health Medical Group | Current |
Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Endeavor Health Medical Group | Emergency Medicine | Current | Accepting new patients |
Locations
9532 Eagle Way
Chicago, IL 60678
2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206
2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175
2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036160081 | IL | Yes |
Addresses
Primary practice location
2650 Ridge Ave
Evanston, IL 60201-1700
Mailing address
2650 Ridge Ave
Evanston, IL 60201-1700
Phone (847) 570-2114
Other providers in Evanston, IL
- Advanced Periodontics and Implants, LTD
- Advanced Psychology LLC
- Aequi Balance Counseling
- Afg Guidance Center LTD
- Indu Agarwal
- Sarah Agne
- Meghana Agni
- Peter Agostino
- Lorraine Aguada
- Mark Perez Agustin
All providers in Evanston, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.