Anthony Adeniran, MD

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001333 Issued in PR

Practice address

877 Pembrook CT
Carol Stream, IL 60188-3077

Phone

(331) 551-2817

NPI assigned

Sep 9, 2010

Last updated

Nov 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1275840357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5082",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605225082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 PEMBROOK CT",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601883077",
            "telephone_number": "331-551-2817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 Kensington Rd",
            "address_purpose": "LOCATION",
            "city": "Oak Brook",
            "state": "IL",
            "postal_code": "605232131",
            "country_code": "US",
            "telephone_number": "331-551-2817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADENIRAN",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-09",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "1333",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "001333",
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238.000099",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOBIERNO DE PUERTO RICO DEPARTAMENTO DE SALUD",
            "identifier": "001333",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOBIERNO DE PUERTO RICO DEPARTAMENTO DE SALUD",
            "identifier": "1333",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ABSA",
            "identifier": "99-264",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Samreen Ahmed, DDS
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• Physician Assistant in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.