Provider Demographics
NPI:1063452845
Name:BADEJO, ADELEKE E (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ADELEKE
Middle Name:E
Last Name:BADEJO
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CENTRAL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2949
Mailing Address - Country:US
Mailing Address - Phone:308-234-9822
Mailing Address - Fax:
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-234-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19006207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE140007700OtherRAILROAD MEDICARE
KS100143550CMedicaid
NE35675OtherBLUE CROSS & BLUE SHIELD
KS102023OtherBLUE CROSS & BLUE SHIELD
NE47084506100Medicaid
KS100143550BMedicaid
NEF53479Medicare UPIN
NE35675OtherBLUE CROSS & BLUE SHIELD
NE47084506100Medicaid