DR. AGBOOLA AWOMOLO (NPI# 1073877262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073877262 |
| Entity Type | Individual |
| Full Name | DR. AGBOOLA AWOMOLO |
| Credential | M.D. |
| Practice Address |
4646 N Marine Dr Chicago IL 60640-5759 |
| Mailing Address |
15537 Ingleside Ave Dolton IL 60419-2759 |
| Practice Telephone | 7738788700 |
| Mailing Telephone | 7734301254 |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
3694807 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
4646 N MARINE DR |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-5759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407850969 | Peter A Hancock | Podiatrist | 4646 N Marine Dr, Ste C-6500, Chicago, IL 60640-5759 | 2005-06-11 |
| 1881200368 | Chandan Singh Sapkota | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-09-19 |
| 1538771316 | Ayesha Saleem | Student in an Organized Health Care Education/Training Program | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-21 |
| 1831701978 | Allina Ghimire | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-19 |
| 1154932291 | Ayomide Ireti Sotomi-foluso | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-12 |
| 1427669860 | Yadana Oo | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-10 |
| 1467062190 | Seyma Eroglu | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-07 |
| 1003426743 | Carlos Andres Rueda Mantilla | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-07 |
| 1609486968 | Ahmet Ersin Yassa | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-08-03 |
| 1861000630 | Mustafa Ali Samejo | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2020-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754233 | Rci (wrs), LLC. | Clinic/Center | 5221-23 North Broadway, Chicago, IL 60640 | 2020-09-09 |
| 1548871916 | Borici Counseling LLC | Counselor | 4731 N Paulina St, Chicago, IL 60640 | 2020-08-11 |
| 1306319173 | Gerardo Garcia | Physician Assistant | Medical Staff Office, Weiss Memorial Hospital, 4646 N Marine Drive, Chicago, IL 60640 | 2019-01-04 |
| 1386121283 | Aea Optical Ventures, LLC | Clinic/Center | 4814 N Clark St, Chicago, IL 60640 | 2018-07-24 |
| 1023503885 | Lauren Vassiliades | Internal Medicine | Weiss Memorial Hospital, Medical Education Dpt., 4646 N. Marine Drive, C Elevators, 7th Flr. # 7100, Chicago, IL 60640 | 2018-06-25 |
| 1477061620 | Yesenia Vargas | Nurse Practitioner | 1025 W Sunnyside, Chicago, IL 60640 | 2018-01-22 |
| 1932622206 | Jasleen Kaur Brar | Internal Medicine | 4646 N. Marine Dr., Chicago, IL 60640 | 2017-07-19 |
| 1750802849 | Umer Mukhtar | Internal Medicine | 4646 N. Marine Dr. Med Ed Dept. C Elevators., Weiss Memorial Hospital. 7 Floor. #7100, Chicago, IL 60640 | 2017-06-29 |
| 1184144081 | Ellie Navidson | Registered Nurse | 1015 W Lawrence, 2nd Floor, Chicago, IL 60640 | 2017-06-21 |
| 1962932558 | Jennifer Stridh | Marriage & Family Therapist | 5125 N. Winthrop Ave, 1f, Chicago, IL 60640 | 2017-06-15 |
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| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376196220 | Parvathamma Imaging Services, LLC | Radiology | 7431 S East End Ave Ste 2, Chicago, IL 60649-3611 | 2019-07-19 |
| 1225516842 | Tyler Jonathan Hinkel | Radiology | 33 W Ontario St Apt 46f, Chicago, IL 60654 | 2018-08-06 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1790132934 | Peter Barton Moreau | Radiology | 1740 W Taylor St Rm 2483, Chicago, IL 60612-7232 | 2016-05-18 |
| 1043678899 | Burce Ozgen Mocan | Radiology | 1740 W Taylor St Rm 2511, Department of Radiology (mc931), Chicago, IL 60612-7232 | 2016-02-08 |
| 1538552898 | Imo Ime Uko | Radiology | 4646 N Marine Dr Ste 7100, Chicago, IL 60640 | 2015-03-11 |
| 1962891739 | Katherine Conlon | Radiology | 240 E Huron St # 1-203, Chicago, IL 60611 | 2015-01-16 |
| 1861805871 | Arun Nagaraju | Radiology | 5841 S. Maryland Ave. Suite Mc2026, University of Chicago, Chicago, IL 60637-1448 | 2014-06-06 |
| 1568873529 | Emily Ghobadi | Radiology | 250 E Superior St Rm 4-2304, Chicago, IL 60611-2914 | 2014-05-13 |
| 1306266903 | Jessica Kristen Peterson | Radiology | 250 E Superior St Ste 4-2304, Chicago, IL 60611-2914 | 2014-04-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.