Provider Demographics
NPI:1285689653
Name:ABOLADE, BABATUNDE (MD)
Entity Type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:
Last Name:ABOLADE
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 1:2430 FAIRLANE DR
Mailing Address - Street 2:SUITE C-07
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1642
Mailing Address - Country:US
Mailing Address - Phone:334-551-0735
Mailing Address - Fax:334-551-0767
Practice Address - Street 1:2430 FAIRLANE DR
Practice Address - Street 2:SUITE C-07
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1642
Practice Address - Country:US
Practice Address - Phone:334-551-0735
Practice Address - Fax:334-551-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL256222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523656Medicaid
AL51523656OtherBCBS
AL051523656Medicaid