Timothy Omotayo Adesanya, | |
Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | |
(217) 532-6961 | |
Not Available |
Full Name | Timothy Omotayo Adesanya |
---|---|
Gender | Male |
Speciality | Physician Assistant - Medical |
Location | Graham Correctional Center, Hilliboro, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467001859 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363AM0700X | Physician Assistant - Medical | 085001089 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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Timothy Omotayo Adesanya, Po Box 512, Greenville, IL 62246-0512 Ph: (618) 664-2914 | Timothy Omotayo Adesanya, Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 Ph: (217) 532-6961 |