Provider Demographics
NPI:1033855622
Name:ADEWOLU, TIMOTHY ADEYEMI
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ADEYEMI
Last Name:ADEWOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 EARLY MORNING WAY
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1881
Mailing Address - Country:US
Mailing Address - Phone:832-866-0741
Mailing Address - Fax:281-595-7782
Practice Address - Street 1:8815 EARLY MORNING WAY
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-1881
Practice Address - Country:US
Practice Address - Phone:832-866-0741
Practice Address - Fax:281-595-7782
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)