Provider Demographics
NPI:1477253540
Name:BAMIDELE, ADEGBOYEGA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ADEGBOYEGA
Middle Name:
Last Name:BAMIDELE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 BROOKSIDE AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3776
Mailing Address - Country:US
Mailing Address - Phone:773-931-9206
Mailing Address - Fax:
Practice Address - Street 1:1405 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-1968
Practice Address - Country:US
Practice Address - Phone:773-931-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL027263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist