Provider Demographics
NPI:1972756245
Name:AREGBE, ABDULATEEF OLASUNKANMI (MD)
Entity type:Individual
Prefix:
First Name:ABDULATEEF
Middle Name:OLASUNKANMI
Last Name:AREGBE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10324 CAMBY XING
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5790
Mailing Address - Country:US
Mailing Address - Phone:646-361-4560
Mailing Address - Fax:
Practice Address - Street 1:9894 E 121ST ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4154
Practice Address - Country:US
Practice Address - Phone:317-621-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46973207R00000X
IN01066511A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200941740Medicaid
INP01210474OtherRR MEDICARE PTAN
000000618197OtherANTHEM
INP01210474OtherRR MEDICARE PTAN
IN200941740Medicaid
IN266180207Medicare PIN