Provider Demographics
NPI:1386174357
Name:ADEBIYI, BOLANLE (MD)
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:ADEBIYI
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 1:1202 SW 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1283
Mailing Address - Country:US
Mailing Address - Phone:352-505-1301
Mailing Address - Fax:352-505-9846
Practice Address - Street 1:2801 SE 1ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0478
Practice Address - Country:US
Practice Address - Phone:352-505-1301
Practice Address - Fax:352-505-9846
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME130997OtherMEDICAL LICENSE