Provider Demographics
NPI:1033190038
Name:ABIOSE, ADEMOLA K (MD)
Entity Type:Individual
Prefix:
First Name:ADEMOLA
Middle Name:K
Last Name:ABIOSE
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 1:29325 HEALTH CAMPUS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8201
Mailing Address - Country:US
Mailing Address - Phone:440-414-9400
Mailing Address - Fax:216-201-5591
Practice Address - Street 1:125 E BROAD ST STE 305
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6447
Practice Address - Country:US
Practice Address - Phone:440-414-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096539207R00000X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3154321Medicaid
OHH000930Medicare PIN
OH3154321Medicaid