Provider Demographics
NPI:1477206688
Name:IFABIYI, AJEWOLE
Entity Type:Individual
Prefix:
First Name:AJEWOLE
Middle Name:
Last Name:IFABIYI
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 1:2933 SUNNYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-3180
Mailing Address - Country:US
Mailing Address - Phone:615-600-1924
Mailing Address - Fax:
Practice Address - Street 1:2933 SUNNYFIELD CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-3180
Practice Address - Country:US
Practice Address - Phone:615-600-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health