Provider Demographics
NPI:1417563651
Name:ADEKAMBI, IDOWU OLUWAFEMI
Entity Type:Individual
Prefix:
First Name:IDOWU
Middle Name:OLUWAFEMI
Last Name:ADEKAMBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16126 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4407
Mailing Address - Country:US
Mailing Address - Phone:786-342-8527
Mailing Address - Fax:
Practice Address - Street 1:16126 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4407
Practice Address - Country:US
Practice Address - Phone:786-342-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily