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Adebowale Tolulade Adesida

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1969 W Ogden Ave, Chicago, IL 60612-3765

PECOS Enrollment

This provider is enrolled in PECOS as ADEBOWALE ADESIDA.

Based on the most recent information from CMS, provider Adebowale Tolulade Adesida is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1093407868
Provider Type
Individual
Full Name
Adesida, Adebowale Tolulade
Gender
Male

Sole Proprietor
Yes
Enumeration Date
5/22/2023
Last Updated
5/22/2023

Contact Information

Practice Location

1969 W Ogden Ave, Chicago, IL 60612-3765

(610) 547-3243

Unlisted Fax

Mailing Location

915 N East Ave, Oak Park, IL 60302-1329

(610) 547-3243

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 085.009676 Illinois

Adebowale Tolulade Adesida

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Gronski, Ellery

Freeman, Bethann

Rogowski, Wendy Ann

Frieh, Melanie

Johnson, Hannah Grace

Quemeneur, Alexis Caryl

Latif, Rohiya Hakimi

Schock, Lindsey

Karuthalackal, Adai V

Lukic, Nikola Aleksandar