Provider Demographics
NPI:1558562603
Name:BADEWA, ABIODUN PHILIP (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ABIODUN
Middle Name:PHILIP
Last Name:BADEWA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ABIODUN
Other - Middle Name:AKINBOYE
Other - Last Name:BADEWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-5311
Mailing Address - Country:US
Mailing Address - Phone:205-358-9300
Mailing Address - Fax:205-358-9306
Practice Address - Street 1:1007 9TH AVE N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-5311
Practice Address - Country:US
Practice Address - Phone:205-358-9300
Practice Address - Fax:205-358-9306
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28254207Q00000X
ALMD.28254207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115578Medicaid
FB0284579OtherDEA
102I087214Medicare PIN