1568725877 NPI number — DR. SHERIFAT AJIBIKE OPE ADENUGA M.D

Table of content: DR. SHERIFAT AJIBIKE OPE ADENUGA M.D (NPI 1568725877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568725877 NPI number — DR. SHERIFAT AJIBIKE OPE ADENUGA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPE ADENUGA
Provider First Name:
SHERIFAT
Provider Middle Name:
AJIBIKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OPE
Provider Other First Name:
SHERIFAT
Provider Other Middle Name:
AJIBIKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568725877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3260 PROVIDENCE DR
Provider Second Line Business Mailing Address:
STE 322
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-4661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-563-5151
Provider Business Mailing Address Fax Number:
907-563-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3260 PROVIDENCE DR
Provider Second Line Business Practice Location Address:
STE 322
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-563-5151
Provider Business Practice Location Address Fax Number:
907-563-6278
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  110947 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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