Provider Demographics
NPI:1073034294
Name:ADEOGUN, ADEKUNLE (MD)
Entity Type:Individual
Prefix:MR
First Name:ADEKUNLE
Middle Name:
Last Name:ADEOGUN
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:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-1565
Mailing Address - Country:US
Mailing Address - Phone:240-406-0861
Mailing Address - Fax:
Practice Address - Street 1:2304 OAK LN STE 114
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8813
Practice Address - Country:US
Practice Address - Phone:469-454-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32059015472OtherSTATE