Provider Demographics
NPI:1962414656
Name:AKEREDOLU, ADEOLA CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:ADEOLA
Middle Name:CATHERINE
Last Name:AKEREDOLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11148 HARPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213
Mailing Address - Country:US
Mailing Address - Phone:313-579-5000
Mailing Address - Fax:313-922-8045
Practice Address - Street 1:11148 HARPER AVENUE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213
Practice Address - Country:US
Practice Address - Phone:313-579-5000
Practice Address - Fax:313-922-8045
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3292188 TYPE 10Medicaid
G51656Medicare UPIN
OM38950Medicare ID - Type Unspecified