Provider Demographics
NPI:1275983801
Name:ODUGBESI, ADEOLA TITILAYO (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEOLA
Middle Name:TITILAYO
Last Name:ODUGBESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2902
Mailing Address - Fax:319-356-8682
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-8242
Practice Address - Fax:319-384-6306
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10630390200000X
IAMD-487912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program