1487495909 NPI number — ADEFISAYO AYOADE ADEKANMBI M.D.

Table of content: ADEFISAYO AYOADE ADEKANMBI M.D. (NPI 1487495909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487495909 NPI number — ADEFISAYO AYOADE ADEKANMBI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEKANMBI
Provider First Name:
ADEFISAYO
Provider Middle Name:
AYOADE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487495909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2395, 1318 EVERSYDE AVENUE SOUTH WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALGARY
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T2YOB5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BOSTON MEDICAL PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-638-8994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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