Provider Demographics
NPI:1477505758
Name:ADEWUMI, COMFORT OMOBOLA (DO)
Entity Type:Individual
Prefix:DR
First Name:COMFORT
Middle Name:OMOBOLA
Last Name:ADEWUMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17439 NW 66TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4431
Mailing Address - Country:US
Mailing Address - Phone:305-974-5750
Mailing Address - Fax:305-757-4443
Practice Address - Street 1:18356 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2934
Practice Address - Country:US
Practice Address - Phone:305-974-5750
Practice Address - Fax:305-757-4443
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81516ZOtherMEDICARE ID
FLI00973Medicare UPIN