Provider Demographics
NPI:1437713732
Name:ADESHOLA, ADEREMI
Entity Type:Individual
Prefix:
First Name:ADEREMI
Middle Name:
Last Name:ADESHOLA
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 1:11 CROCUS PETAL ST
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2808
Mailing Address - Country:US
Mailing Address - Phone:832-922-1333
Mailing Address - Fax:
Practice Address - Street 1:11 CROCUS PETAL ST
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2808
Practice Address - Country:US
Practice Address - Phone:832-922-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver