Provider Demographics
NPI:1073271540
Name:AJEWOLE MEDICAL PLLC
Entity Type:Organization
Organization Name:AJEWOLE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUNKANMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AJEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-687-7282
Mailing Address - Street 1:338 HARRIS HILL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7470
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:3 UPTON PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1500
Practice Address - Country:US
Practice Address - Phone:585-685-2525
Practice Address - Fax:585-385-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty