Johnson O Adeleke

Individual provider Active NPI Non-emergency Medical Transport (VAN) · Calumet City, IL

NPI 1326323494 · NPPES record last updated Oct 20, 2011

Key facts

NPI
1326323494
Entity type
Individual (NPI type 1)
Primary specialty
Non-emergency Medical Transport (VAN) 343900000X
License
67809629 (IL)
Practice address
387 Luella Ave
Calumet City, IL 60409-2207
Phone
(708) 868-8551
Fax
(708) 868-8551
NPI assigned
Oct 20, 2011
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
67809629ILMDNon-emergency Medical Transport (VAN)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Non-emergency Medical Transport (VAN) 343900000X 67809629 IL Yes

Addresses

Primary practice location

387 Luella Ave
Calumet City, IL 60409-2207

Mailing address

387 Luella Ave
Calumet City, IL 60409-2207
Phone (708) 868-8551

Other providers in Calumet City, IL

All providers in Calumet City, IL · Non-emergency Medical Transport (VAN) in Illinois

Sources for this page

Verify at the official NPI Registry.