Provider Demographics
NPI:1699904268
Name:ADEYEMO, ADEBOWALE M
Entity type:Individual
Prefix:MR
First Name:ADEBOWALE
Middle Name:M
Last Name:ADEYEMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4982
Mailing Address - Country:US
Mailing Address - Phone:972-679-0057
Mailing Address - Fax:918-794-6656
Practice Address - Street 1:5515 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4982
Practice Address - Country:US
Practice Address - Phone:972-679-0057
Practice Address - Fax:918-794-6656
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-04
Last Update Date:2009-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health