Provider Demographics
NPI:1568570653
Name:ADEOSUN, ANTHONY K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:K
Last Name:ADEOSUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:333 DOCTOR MICHAEL DEBAKEY DR
Mailing Address - Street 2:SUITE120
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5887
Mailing Address - Country:US
Mailing Address - Phone:337-433-4077
Mailing Address - Fax:337-433-5598
Practice Address - Street 1:333 DOCTOR MICHAEL DEBAKEY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5887
Practice Address - Country:US
Practice Address - Phone:337-493-8480
Practice Address - Fax:337-493-8482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-07-28
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Provider Licenses
StateLicense IDTaxonomies
MS14928207Q00000X
LAMD202004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117499Medicaid
LA1638820Medicaid
MS00117499Medicaid
LA1638820Medicaid