Provider Demographics
NPI:1437444007
Name:ADEBOGUN, AKEEM OLABANJI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:AKEEM
Middle Name:OLABANJI
Last Name:ADEBOGUN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:12001 SOUTH FWY STE 300
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7215
Practice Address - Country:US
Practice Address - Phone:682-268-6670
Practice Address - Fax:682-268-6671
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9044207RG0100X
DCMD044027207R00000X
OH35.126515207RG0100X
WV3211207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program