Provider Demographics
NPI:1992981302
Name:IBIKUNLE, CHRISTOPHER ALADE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALADE
Last Name:IBIKUNLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALADE
Other - Middle Name:OLORUNSHOLA
Other - Last Name:IBIKUNLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:367 ATHENS HWY
Mailing Address - Street 2:BUILDING 100 SUITE 100A
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2204
Mailing Address - Country:US
Mailing Address - Phone:678-466-6760
Mailing Address - Fax:678-802-7094
Practice Address - Street 1:367 ATHENS HWY
Practice Address - Street 2:BUILDING 100 SUITE 100A
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2204
Practice Address - Country:US
Practice Address - Phone:678-466-6760
Practice Address - Fax:678-802-7094
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066703208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I025985Medicare PIN