Kolawole Olufemi Dominik Sofowora, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036.142733 Issued in IL

Practice address

165 E Plank Rd
Sycamore, IL 60178

Phone

(815) 363-9400

Fax

(314) 454-4102

NPI assigned

Jul 1, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: kolawole.sofowora.p1@direct.gefcc.nextgenshare.com

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1124434964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 SUMMIT ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "60120",
            "telephone_number": "847-608-1344",
            "fax_number": "314-454-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 E PLANK RD",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60178",
            "telephone_number": "815-363-9400",
            "fax_number": "314-454-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOFOWORA",
        "first_name": "KOLAWOLE",
        "middle_name": "OLUFEMI DOMINIK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.142733",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2014019161",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Alan Sloan, D.D.S
• David Dewitt Smiley, MSN, APRN, FNP-BC
• Arlyn Dingel Smith, APRN, CNP
• William David Smith, DC, PT
• Tiera Snelling, LSW
• Haley Allyson Spengler
• Cheri Lynn Sprietler, NP APN
• Marcus Stammen, DO
• Ashli Stanfa, FNP-BC
• Matthew Stark, MS, RDN, LDN

• Pediatrics Physician in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.