Provider Demographics
NPI:1699749572
Name:OLUFEMI OLADELE-AJOSE MD PC
Entity type:Organization
Organization Name:OLUFEMI OLADELE-AJOSE MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLADELE-AJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-754-7749
Mailing Address - Street 1:118 W WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1247
Mailing Address - Country:US
Mailing Address - Phone:319-754-7749
Mailing Address - Fax:319-754-7756
Practice Address - Street 1:118 W WHEELER ST
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1247
Practice Address - Country:US
Practice Address - Phone:319-754-7749
Practice Address - Fax:319-754-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49346OtherWELLMARK
IA0400383Medicaid
IA=========OtherJOHN DEERE
IA=========OtherJOHN DEERE
IA49401Medicare ID - Type Unspecified