Provider Demographics
NPI:1992074298
Name:ADEKOLA, ORITSEGBUBEMI EGHOSA (MD)
Entity type:Individual
Prefix:DR
First Name:ORITSEGBUBEMI
Middle Name:EGHOSA
Last Name:ADEKOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ORITSEGBUBEMI
Other - Middle Name:EGHOSA
Other - Last Name:OLUPITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1560 E MAPLE ROAD
Mailing Address - Street 2:STE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1135
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-745-0011
Practice Address - Street 1:4160 JOHN R ST STE 917
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101063207R00000X, 208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist