Individual provider Active NPI

Oluwagbenga Afiamoye Ojo

  • Driver
  • Chicago, IL
National Provider Identifier
1104435551
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
License
O20064172210 Issued in IL
Practice address
6969 N Ashland Blvd Unit 101
Chicago, IL 60626-3354
Phone
(773) 807-5133
NPI assigned
Jul 30, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X O20064172210 IL Primary

Addresses

Primary practice location

6969 N Ashland Blvd Unit 101
Chicago, IL 60626-3354

Mailing address

6969 N Ashland Blvd Unit 101
Chicago, IL 60626-3354
Phone (773) 807-5133

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
O20064172210ILMDDriver

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1104435551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6969 N ASHLAND BLVD UNIT 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263354",
            "telephone_number": "773-807-5133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6969 N ASHLAND BLVD UNIT 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263354",
            "telephone_number": "773-807-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OJO",
        "first_name": "OLUWAGBENGA",
        "middle_name": "AFIAMOYE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "IL",
            "license": "O20064172210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.