| 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 |
|---|---|
| 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 |