Provider Demographics
NPI:1568753481
Name:ADELEKE, ADEGOKE OLAOLU I (MD, MSM)
Entity Type:Individual
Prefix:DR
First Name:ADEGOKE
Middle Name:OLAOLU
Last Name:ADELEKE
Suffix:I
Gender:M
Credentials:MD, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-820-2000
Mailing Address - Fax:
Practice Address - Street 1:104 E. HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-7381
Practice Address - Country:US
Practice Address - Phone:417-934-2251
Practice Address - Fax:417-934-2871
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000034207Q00000X
TXS5109207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1568753481Medicaid
MO132300553Medicare PIN