Provider Demographics
NPI:1003066440
Name:ADENUGA, ADEKOYEJO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEKOYEJO
Middle Name:B
Last Name:ADENUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-265-1981
Mailing Address - Fax:517-263-1001
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:SUITE B2
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-265-1981
Practice Address - Fax:517-263-1001
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101149OtherGREAT LAKES HEALTH PLAN
MI6862713OtherCIGNA
MI03774OtherPARAMOUNT HEALTHCARE
MI5697OtherHEALTH PLAN OF MICHIGAN
MI7000339381OtherPRIORITY HEALTH CARE
MI0461056OtherBCBS
MI4843556Medicaid
MI7000339381OtherPRIORITY HEALTH CARE