Provider Demographics
NPI:1194917310
Name:WINDOKUN, ADEJARE (MD)
Entity type:Individual
Prefix:DR
First Name:ADEJARE
Middle Name:
Last Name:WINDOKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 MCCULLOCH BLVD N STE A12
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6777
Mailing Address - Country:US
Mailing Address - Phone:928-302-1505
Mailing Address - Fax:310-999-6587
Practice Address - Street 1:1845 MCCULLOCH BLVD N STE A12
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6777
Practice Address - Country:US
Practice Address - Phone:928-302-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90058207L00000X
IN01065872A207L00000X
AZ41043207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000593704OtherANTHEM PROVIDER NUMBER
IN200523260Medicaid
IN200523260Medicaid
IN000000593704OtherANTHEM PROVIDER NUMBER