IndividualActive
Mofesola Modupe, DO
NPI 1457932014 · Student in an Organized Health Care Education/Training Program · Peoria, IL
Provider details
- NPI number
- 1457932014
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- License
- 90200000X
Specialties & taxonomies
Student, Health Care
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
530 Ne Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 665-2274
Street-level locationGet directions
Mailing address
530 Ne Glen Oak Ave
Peoria, IL 61637-0001
Registry dates
- Enumerated
- 2021-04-15
- Last updated
- 2021-04-15
- Certified
- 2021-04-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.